Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 7002 | NC |
NPI | 1619297496 |
---|---|
Provider Name | Sarah Ellen Fleming |
First Address | Raleigh, NC 27615-4320 |
Second Address | Raleigh, NC 27615-4320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 03/06/2010 |