Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1093863862 |
---|---|
Provider Name | Julie Bragg |
First Address | Henderson, NC 27536-2878 |
Second Address | Henderson, NC 27536-2878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 14/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046KY | BCBS (01) | NC |
7703875 | (05) | NC |
7795259 | (05) | NC |
7795286 | (05) | NC |