Individual
QUANIQUA POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 MARTIN LUTHER KING JR. DR., 432 FL ATKINS BUILDING, WINSTON-SALEM, NC 27110
(336) 750-2000
Mailing address
363 GEORGE BIG REDD CT APT 202, WINSTON SALEM, NC 27101-2094
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UKU909495074
BLUE CROSS BLUE SHIELD TENNESSEE
NC
Enumeration date
03/29/2022
Last updated
03/29/2022
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