Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO02450 | NC |
N | 225000000X | Orthotic Fitter | CFTS1014 | NC |
NPI | 1619177334 |
---|---|
Provider Name | Robert Tardell |
First Address | Salisbury, NC 28147-1317 |
Second Address | Salisbury, NC 28147-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 02/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795098 | (05) | NC |