Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1497358410 |
---|---|
Provider Name | Stephanie Brown |
First Address | Anderson, SC 29621-2320 |
Second Address | Williamston, SC 29697-1061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2020 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104973577 | (05) | SC |