Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1952338634 |
---|---|
Provider Name | Mr. Richard Noland |
First Address | Lexington, KY 40509-1759 |
Second Address | Lexington, KY 40509-1764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45903176 | (05) | KY |
90950346 | (05) | KY |