Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 10770 | MA |
Y | 225XG0600X | Occupational Therapist - Gerontology | 11858 | NC |
NPI | 1780920587 |
---|---|
Provider Name | Laura Marie Winters |
First Address | Elizabeth City, NC 27909-8429 |
Second Address | Elizabeth City, NC 27909-7628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/12/2012 |
Last Update Date | 20/04/2020 |