Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0119002872 | VA |
Y | 225X00000X | Occupational Therapist | 7400 | NC |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0119002872 | VA |
NPI | 1134565781 |
---|---|
Provider Name | Mrs. Wrenda Jo Trent |
First Address | Kitty Hawk, NC 27949-9226 |
Second Address | Kitty Hawk, NC 27949-9226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 25/03/2020 |