Healthcare Provider Details

I. General information

NPI: 1346156023
Provider Name (Legal Business Name): LAUREN MEZZANOTTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 N HARNETT SCHOOL RD
ANGIER NC
27501-8480
US

IV. Provider business mailing address

112 WHITE BURLEY CT
DURHAM NC
27703-6475
US

V. Phone/Fax

Practice location:
  • Phone: 919-639-4480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number14345
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: