Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3924 | NC |
NPI | 1013177476 |
---|---|
Provider Name | Lyda S Reese |
First Address | Taylorsville, NC 28681-3587 |
Second Address | Wilkesboro, NC 28697-9472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 10/06/2008 |