Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 7698 | NC |
NPI | 1245530005 |
---|---|
Provider Name | Zach A Story |
First Address | Cary, NC 27513-5263 |
Second Address | Graham, NC 27253-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2010 |
Last Update Date | 02/08/2011 |