Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 11970 | NC |
NPI | 1013495035 |
---|---|
Provider Name | Kyndle Brooke Taylor |
First Address | Concord, NC 28025-8414 |
Second Address | Concord, NC 28025-8414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2018 |
Last Update Date | 01/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BCJAN5983140 | BLUECROSS BLUESHIELD (01) | NC |