Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 11453 | NC |
NPI | 1386124493 |
---|---|
Provider Name | Shayla A Prioleau |
First Address | Charlotte, NC 28262-8557 |
Second Address | Charlotte, NC 28262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |