Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2542 | NC |
NPI | 1740697390 |
---|---|
Provider Name | Mrs. Susan White |
First Address | Bahama, NC 27503-9633 |
Second Address | Bahama, NC 27503-9633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2014 |
Last Update Date | 15/07/2014 |