Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO04693 | PA |
NPI | 1447834692 |
---|---|
Provider Name | Janessa Capozzolo |
First Address | Bangor, PA 18013-9603 |
Second Address | Bangor, PA 18013-9603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2021 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008381761 | ORTHOTIC FITTER (01) | PA |