Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2570 | NC |
NPI | 1902178163 |
---|---|
Provider Name | Mrs. Nicole Krob |
First Address | Monroe, NC 28110-7685 |
Second Address | Monroe, NC 28110-7685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2012 |
Last Update Date | 03/02/2012 |