Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1740448802 |
---|---|
Provider Name | Mrs. Johnnie Mae Owens |
First Address | Clinton, MS 39056-3663 |
Second Address | Clinton, MS 39056-3663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 21/07/2011 |