Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 7659 | NC |
NPI | 1306243654 |
---|---|
Provider Name | Tara Brown |
First Address | Charlotte, NC 28210-8407 |
Second Address | Charlotte, NC 28210-8407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2014 |
Last Update Date | 02/12/2014 |