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NPI Code Detail

MEDICARE: LADONNA SHANTEE KING OTR/L

MEDICARE: LADONNA SHANTEE KING OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist8649NC

General Provider Information

NPI Number : 1215279641
Entity Type Code : Individual
Provider Name (Legal Business Name) : LADONNA SHANTEE KING OTR/L
Provider Business Mailing Address
First Line : 849 WATERWORKS RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27101-1956
Country : US
Telephone Number : 336-559-2166
Fax Number :
Provider Business Practice Location Address
First Line : 849 WATERWORKS RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27101-1956
Country : US
Telephone Number : 336-559-2166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2013
Last Update Date : 03/24/2013

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