Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C46877 | NC |
NPI | 1760709695 |
---|---|
Provider Name | Michelle Creech-Sutton |
First Address | Greenville, NC 27834-2856 |
Second Address | Greenville, NC 27834-2856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 03/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7704999 | (05) | NC |