Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0022 | NC |
N | 225XP0200X | Occupational Therapist - Pediatrics | 22 | NC |
NPI | 1073604344 |
---|---|
Provider Name | Mrs. Sandra Skellie Bruns |
First Address | Asheville, NC 28805-1533 |
Second Address | Asheville, NC 28805-1533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 17/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1426Y | BCBSNC (01) | NC |
190695 | MEDCOST (01) | NC |
7301925 | (05) | NC |