Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | CFO03775 | TN |
NPI | 1942780580 |
---|---|
Provider Name | Matthew D Stimson |
First Address | Knoxville, TN 37931-4552 |
Second Address | La Follette, TN 37766-2912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 14/08/2018 |