Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4776 | NC |
NPI | 1740503812 |
---|---|
Provider Name | Ms. Harrietthall Hall Witherspoon |
First Address | Southport, NC 28461-3538 |
Second Address | Southport, NC 28461-3538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2010 |
Last Update Date | 03/03/2010 |