Individual
THATSANI ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
731 BROAD ST STE A, DURHAM, NC 27705-4863
(919) 316-8691
Mailing address
731 BROAD ST STE A, DURHAM, NC 27705-4863
(919) 316-8691
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4032610525
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BFP103887399
BLUE CROSS BLUE SHIELD
NC
Enumeration date
11/11/2021
Last updated
11/11/2021
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