Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 9719 | NC |
NPI | 1003283284 |
---|---|
Provider Name | Elisabeth Neely Theodossiou |
First Address | Charlotte, NC 28203-5814 |
Second Address | Charlotte, NC 28203-5814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2015 |
Last Update Date | 24/08/2015 |