Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1376872192 |
---|---|
Provider Name | Mr. Jeff Wayne Sprinkle |
First Address | Spartanburg, SC 29302-2650 |
Second Address | Spartanburg, SC 29302-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2009 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13768721921 | INDIVIDUAL NPI NUMBER (01) | SC |
7795443 | (05) | NC |
DE2685 | (05) | SC |