Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFM02267 | NC |
NPI | 1619282217 |
---|---|
Provider Name | Susan D Keith |
First Address | Wilmington, NC 28412-6439 |
Second Address | Whiteville, NC 28472-3416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2010 |
Last Update Date | 09/08/2010 |