Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | C21593 | TX |
NPI | 1386915809 |
---|---|
Provider Name | Willis Bickley |
First Address | Silver Spring, MD 20910-1230 |
Second Address | Silver Spring, MD 20910-1230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2012 |
Last Update Date | 13/01/2012 |