Individual
DOKOTA BOSTON WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
720 OLD CHEROKEE RD, LEXINGTON, SC 29072-9406
(336) 661-5169
Mailing address
4702 OLD RURAL HALL RD, WINSTON SALEM, NC 27105-2447
(336) 661-5169
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4632
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
349975
NCBOT
—
Enumeration date
11/12/2015
Last updated
11/12/2015
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