Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | R-2791 | KY |
N | 225000000X | Orthotic Fitter | R2791 | KY |
NPI | 1053397448 |
---|---|
Provider Name | Mrs. Patricia Jeanene Harlan |
First Address | Albany, KY 42602 |
Second Address | Albany, KY 42602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 20/05/2013 |