| NPI | 1538839915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVERENCE OUTLAW Recreational Therapist 336-604-4537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 225800000X Recreation Therapist |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2022-01-12 |