Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | 5962 | FL |
NPI | 1962742858 |
---|---|
Provider Name | Miss Jennifer Nicole Cruise |
First Address | Spartanburg, SC 29302-4628 |
Second Address | Spartanburg, SC 29302-4628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2013 |
Last Update Date | 28/02/2013 |