Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 7888 | NC |
NPI | 1881156685 |
---|---|
Provider Name | Mrs. Holly Moody |
First Address | Mocksville, NC 28041 |
Second Address | Mocksville, NC 28041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |