Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 9354 | NC |
NPI | 1003336439 |
---|---|
Provider Name | Laura Maclean |
First Address | Faison, NC 28341-0123 |
Second Address | Mount Olive, NC 28365-1917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 27/06/2017 |