Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2350 | NC |
NPI | 1043335110 |
---|---|
Provider Name | Penny S Hage |
First Address | Raleigh, NC 27609-6125 |
Second Address | Raleigh, NC 27609-6125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |