Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1130 | NC |
NPI | 1679971683 |
---|---|
Provider Name | Mr. Michael Anderson |
First Address | Lewisville, NC 27023-8213 |
Second Address | Lewisville, NC 27023-8213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2014 |
Last Update Date | 08/12/2014 |