Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119004751 | VA |
NPI | 1003148594 |
---|---|
Provider Name | Kristin Nuckols |
First Address | Cary, NC 27513-5303 |
Second Address | Cary, NC 27513-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2010 |
Last Update Date | 30/12/2013 |