Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1164725628 |
---|---|
Provider Name | Ms. Nancy Baker Wolk |
First Address | Raleigh, NC 27609-3663 |
Second Address | Raleigh, NC 27607-6462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2010 |
Last Update Date | 06/12/2010 |