Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 70398 | SC |
NPI | 1013465756 |
---|---|
Provider Name | Marquetta Breslin |
First Address | Summerville, SC 29483-5334 |
Second Address | Summerville, SC 29483-5334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2016 |
Last Update Date | 12/09/2016 |