Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1862 | NC |
NPI | 1033260336 |
---|---|
Provider Name | Mrs. Nancy Elizabeth Johnson |
First Address | Greensboro, NC 27455-1154 |
Second Address | Greensboro, NC 27403-2135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 08/07/2007 |