Individual
MIKAYLA BREANNE BUSH
Active
Individual
MIKAYLA BREANNE BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11650
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11650
NORTH CAROLINA OCCUPATIONAL THERAPY LICENSURE
NC
Enumeration date
04/03/2018
Last updated
04/03/2018
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