Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 10770 | NC |
NPI | 1275153462 |
---|---|
Provider Name | Darius Ingram |
First Address | Charlotte, NC 28210-8407 |
Second Address | Charlotte, NC 28210-8407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2020 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10770 | NCBOT (01) | NC |