Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 7795378 | NC |
NPI | 1780858126 |
---|---|
Provider Name | Mr. Robert L Crouch |
First Address | Eden, NC 27288-3329 |
Second Address | Eden, NC 27288-3329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 04/06/2008 |