Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 9702 | NC |
Y | 225XM0800X | Mental Health | 9702 | NC |
NPI | 1134506876 |
---|---|
Provider Name | Mrs. Kimberly Anita Godwin |
First Address | Chapel Hill, NC 27514-4220 |
Second Address | Raleigh, NC 27610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2015 |
Last Update Date | 01/05/2015 |