Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFTS1166 | NC |
NPI | 1487950077 |
---|---|
Provider Name | Mary Ellen Haddock |
First Address | Ayden, NC 28513-7252 |
Second Address | Ayden, NC 28513-7252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2011 |
Last Update Date | 31/01/2011 |