Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1205173598 |
---|---|
Provider Name | Ms. Leslie Gage |
First Address | Honolulu, HI 96826-4862 |
Second Address | Honolulu, HI 96826-4862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2013 |
Last Update Date | 20/05/2013 |