Individual
MRS. KORTNEY ANN BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
955 CORRIHER SPRINGS RD, CHINA GROVE, NC 28023-8773
(704) 433-1279
Mailing address
955 CORRIHER SPRINGS RD, CHINA GROVE, NC 28023-8773
(704) 433-1279
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
10421
NC
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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