Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0984 | NC |
NPI | 1003107061 |
---|---|
Provider Name | Ms. Lucinda Varn Collins |
First Address | Mebane, NC 27302-2707 |
Second Address | Burlington, NC 27217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 26/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0984 | OCCUPATIONAL THERAPY NC LICENSE (01) | NC |