Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 3976 | SC |
NPI | 1164723151 |
---|---|
Provider Name | Rebecca Randall |
First Address | Charleston, SC 29403-4114 |
Second Address | Charleston, SC 29403-4114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2010 |
Last Update Date | 08/11/2010 |