Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 208100000X | Physical Medicine & Rehabilitation | | 2016-02583 | NORTH CAROLINA | No |
| 2 | 2081P0010X | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | 04-46045 | KANSAS | No |
| 3 | 2081P0010X | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | 306329 | NEW YORK | No |
| 4 | 390200000X | Student in an Organized Health Care Education/Training Program | | | | No |
| 5 | 2081P0010X | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | 2018031658 | MISSOURI | Yes |