Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3344 | NC |
NPI | 1003082249 |
---|---|
Provider Name | Heather Sutton Banks |
First Address | Jackson, NC 27845-9503 |
Second Address | Jackson, NC 27845-9503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 07/05/2008 |