Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1235539016 |
---|---|
Provider Name | Vanessa Trevathan |
First Address | Graham, NC 27253-2158 |
Second Address | Graham, NC 27253-4014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2014 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7704282 | (05) | NC |