Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | T00720 | KS |
NPI | 1194801019 |
---|---|
Provider Name | Ms. Shannon A Carro |
First Address | Wichita, KS 67218-4140 |
Second Address | Wichita, KS 67202-4304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 15/01/2015 |