Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1942367131 |
---|---|
Provider Name | Mr. Michael Kenneth Nelson |
First Address | Warwick, RI 02886-5202 |
Second Address | Warwick, RI 02886-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |