Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFTS1314 | NC |
NPI | 1063783447 |
---|---|
Provider Name | Leatha Garrison |
First Address | Laurinburg, NC 28352-4724 |
Second Address | Laurinburg, NC 28352-4724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |