Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CPED3326 | NC |
NPI | 1073845152 |
---|---|
Provider Name | Miss Meagan Lauren Phelps |
First Address | Belhaven, NC 27810-9771 |
Second Address | Belhaven, NC 27810-9771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2010 |
Last Update Date | 01/02/2010 |