Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 13401 | NC |
NPI | 1003490087 |
---|---|
Provider Name | Olivia Lickwar |
First Address | Greensboro, NC 27455-2847 |
Second Address | Greensboro, NC 27407-1303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2021 |
Last Update Date | 06/05/2021 |