Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5876 | MA |
NPI | 1235235417 |
---|---|
Provider Name | Miss Nancy Botelho I |
First Address | Fall River, MA 02723-1000 |
Second Address | Fall River, MA 02723-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |