Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 8267 | NC |
NPI | 1023432432 |
---|---|
Provider Name | Kendra Segree |
First Address | Raleigh, NC 27612-3533 |
Second Address | Raleigh, NC 27612-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2014 |
Last Update Date | 06/02/2014 |