Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 115635 | TX |
Y | 225X00000X | Occupational Therapist | 8544 | NC |
N | 225XH1200X | Occupational Therapist - Hand | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 8544 | NC |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 8544 | NC |
NPI | 1598186843 |
---|---|
Provider Name | Scotillia N Mcphaul |
First Address | Charlotte, NC 28216-2447 |
Second Address | Charlotte, NC 28216-2447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2014 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q49100E346 | MEDICARE PTAN (01) | NC |