Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1053505446 |
---|---|
Provider Name | Ms. Patricia L. Kish |
First Address | Reidsville, NC 27320-5330 |
Second Address | Reidsville, NC 27320-5330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 29/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1740278167 | NPI (01) | NC |
7795123 | (05) | NC |
7795193 | (05) | NC |