Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 3125 | NC |
NPI | 1508115171 |
---|---|
Provider Name | Jannie Sue Phillips |
First Address | Conover, NC 28613 |
Second Address | Conover, NC 28613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 29/08/2012 |