Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | CT-1339 | CT |
Y | 156FX1800X | Optician | SC-1171 | SC |
NPI | 1215222369 |
---|---|
Provider Name | Ms. Carlene M Taylor-Harlow |
First Address | Florence, SC 29501-3429 |
Second Address | Florence, SC 29501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 21/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1171 | LICENSED OPTICIAN (01) | SC |