Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFTS1106 |
NPI | 1073815999 |
---|---|
Provider Name | Wendy D Eaton |
First Address | Chattanooga, TN 37411-3603 |
Second Address | Cleveland, TN 37311-3936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2010 |
Last Update Date | 29/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000973794C | (05) | GA |
000973794D | (05) | GA |
000973794E | (05) | GA |
1455062 | (05) | TN |
1507472 | (05) | TN |