Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 13885 | NC |
NPI | 1003486614 |
---|---|
Provider Name | Suzanne Smith |
First Address | Charlotte, NC 28217-4053 |
Second Address | Charlotte, NC 28217-4053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2021 |
Last Update Date | 26/06/2021 |