Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 8734 | NC |
NPI | 1063932630 |
---|---|
Provider Name | Joanne Brown |
First Address | Woodleaf, NC 27054-9757 |
Second Address | Lexington, NC 27295-9140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2017 |
Last Update Date | 23/06/2017 |