Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFT2031 | NC |
NPI | 1154936003 |
---|---|
Provider Name | Jack Bradley Hamilton |
First Address | Clinton, NC 28328-2434 |
Second Address | Clinton, NC 28328-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2020 |
Last Update Date | 08/09/2020 |