Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 10223 | NC |
NPI | 1003358029 |
---|---|
Provider Name | Gabrielle Leister |
First Address | Charlotte, NC 28215-6088 |
Second Address | Salisbury, NC 28147-9079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 04/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10223 | NC OTA LICENSE (01) | NC |