Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 13197 | NC |
NPI | 1124691043 |
---|---|
Provider Name | Heather Mikesell |
First Address | Arden, NC 28704-8500 |
Second Address | Winterville, NC 28590-7992 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 19/07/2021 |