Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1821553355 |
---|---|
Provider Name | Danielle Douglas |
First Address | Burlington, NC 27215-5380 |
Second Address | Burlington, NC 27215-5380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2019 |
Last Update Date | 08/02/2019 |