Individual
GINA WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2778 COUNTRY CLUB DR, HAMPSTEAD, NC 28443-8028
(910) 270-5223
Mailing address
2778 COUNTRY CLUB DR, HAMPSTEAD, NC 28443-8028
(910) 270-5223
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6550
NC
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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