Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4474 | NC |
NPI | 1518413293 |
---|---|
Provider Name | Ms. Janice Whitley |
First Address | Kannapolis, NC 28081-7418 |
Second Address | Charlotte, NC 28262-8436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |