Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | CP003005 | TX |
N | 225000000X | Orthotic Fitter | CP003005 | TX |
NPI | 1376697193 |
---|---|
Provider Name | Mr. Scott Patrick Vicknair |
First Address | Corpus Christi, TX 78463-1580 |
Second Address | Corpus Christi, TX 78404-2214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 09/07/2007 |