Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 12101 | NC |
NPI | 1376011148 |
---|---|
Provider Name | Lauren Brooke Defreitas |
First Address | Raleigh, NC 27610-1750 |
Second Address | Durham, NC 27705-4699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2018 |
Last Update Date | 09/11/2018 |