Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 12683 | NC |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1194251991 |
---|---|
Provider Name | Tarissa Lyn Vreeland |
First Address | Charlotte, NC 28226-5901 |
Second Address | Charlotte, NC 28215-9002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 12/08/2019 |