Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 000007 | GA |
NPI | 1508923020 |
---|---|
Provider Name | Mrs. Allison Boynton Beck |
First Address | Clayton, GA 30525-0049 |
Second Address | Clayton, GA 30525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 09/07/2007 |