Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO05319 | NC |
NPI | 1558035774 |
---|---|
Provider Name | Ms. Allison K Mouse |
First Address | Garner, NC 27529-9240 |
Second Address | Durham, NC 27705-4699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2021 |
Last Update Date | 02/08/2021 |