Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 10509 | NC |
NPI | 1003396383 |
---|---|
Provider Name | Rochelle Masudal |
First Address | Charlotte, NC 28260-3949 |
Second Address | Cary, NC 27518-8161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 09/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003396383 | (05) | NC |