Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1942319553 |
---|---|
Provider Name | Mrs. Kathy Sue Foust |
First Address | Fayetteville, NC 28304 |
Second Address | Fayetteville, NC 28304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 23/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0478V | BCBS (01) | NC |
7795109 | (05) | NC |