Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 0119002850 | VA |
NPI | 1114437480 |
---|---|
Provider Name | Mrs. Kimberly Anne Allan |
First Address | Williamsburg, VA 23185 |
Second Address | Williamsburg, VA 23185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 02/10/2017 |