Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1093881708 |
---|---|
Provider Name | Ms. Sheryl Avon Skipper |
First Address | Thomasville, GA 31792-5400 |
Second Address | Thomasville, GA 31792-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00528294A | (05) | GA |