Individual
CRISTINA PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
206 WATER RIDGE AVE, KANNAPOLIS, NC 28083-6290
(704) 273-9815
Mailing address
206 WATER RIDGE AVE, KANNAPOLIS, NC 28083
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
10398
NC
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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