Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 000823532I | NC |
NPI | 1407153729 |
---|---|
Provider Name | Mr. Timothy Craft Moss |
First Address | Cherryville, NC 28021-3407 |
Second Address | Cherryville, NC 28021-3407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2011 |
Last Update Date | 23/02/2011 |