Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 2013036768 | MO |
NPI | 1417458662 |
---|---|
Provider Name | Whitney Marie Witherspoon |
First Address | Florissant, MO 63034-2227 |
Second Address | Florissant, MO 63034-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2018 |
Last Update Date | 23/02/2018 |