Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1659494938 |
---|---|
Provider Name | Mr. Jeffrey Scott Haskett |
First Address | Charlotte, NC 28203-4742 |
Second Address | Charlotte, NC 28203-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 09/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7700966 | (05) | NC |
7795096 | (05) | NC |