Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 8320 | NC |
NPI | 1689103400 |
---|---|
Provider Name | Reginald Musekiwa |
First Address | Greensboro, NC 27409-9560 |
Second Address | Eden, NC 27288-5239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 06/06/2017 |