Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1003809476 |
---|---|
Provider Name | Mr. John Joseph Kasik SR. |
First Address | Columbia, SC 29212-1651 |
Second Address | Columbia, SC 29212-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 15/04/2016 |