Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1114413986 |
---|---|
Provider Name | Elizabeth Jane Edwards |
First Address | Greensboro, NC 27401-1750 |
Second Address | Greensboro, NC 27401-1750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 05/07/2018 |