Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 9129 | NC |
NPI | 1780224980 |
---|---|
Provider Name | Mrs. Emily Rexrode Commander |
First Address | Durham, NC 27713-8004 |
Second Address | Burlington, NC 27215-5695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2020 |
Last Update Date | 15/01/2020 |