Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5227 | NC |
NPI | 1417499054 |
---|---|
Provider Name | Dwayne Smith |
First Address | Ocean Isle Beach, NC 28469-4741 |
Second Address | Ocean Isle Beach, NC 28469-4741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2016 |
Last Update Date | 14/11/2016 |