Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4680 | NC |
NPI | 1023284577 |
---|---|
Provider Name | Ms. Agnes Whisnant Collins |
First Address | Morganton, NC 28655-8800 |
Second Address | Gastonia, NC 28052-2110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 05/05/2008 |