Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C50918 | NC |
NPI | 1457695553 |
---|---|
Provider Name | Pam Campbell |
First Address | Rockingham, NC 28379-4317 |
Second Address | Rockingham, NC 28379-4317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |