Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | NY |
NPI | 1659414829 |
---|---|
Provider Name | Mrs. Shirley Ann Dickinson |
First Address | Potsdam, NY 13676-9658 |
Second Address | Potsdam, NY 13676-9658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 12/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0565186 | (05) | NY |