Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 552 | NC |
NPI | 1265464002 |
---|---|
Provider Name | Mrs. Melinda Gail Evans |
First Address | Winston Salem, NC 27114-5626 |
Second Address | Winston Salem, NC 27103-6946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2510810 | (02) | NC |