Healthcare Provider Details

I. General information

NPI: 1184817074
Provider Name (Legal Business Name): AARON SAMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 AMANDA PL
WINTERVILLE NC
28590-9830
US

IV. Provider business mailing address

2545 AMANDA PL
WINTERVILLE NC
28590-9830
US

V. Phone/Fax

Practice location:
  • Phone: 252-215-1118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number2511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: