Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1982857272 |
---|---|
Provider Name | Mr. Bob Jeffrey Hampton |
First Address | Greenville, SC 29616 |
Second Address | Simpsonville, SC 29681 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 30/10/2008 |