Healthcare Provider Details

I. General information

NPI: 1780224980
Provider Name (Legal Business Name): EMILY REXRODE COMMANDER OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY KATHRYN REXRODE OT/L

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S MEBANE ST
BURLINGTON NC
27215-5695
US

IV. Provider business mailing address

5116 OAKBROOK DR
DURHAM NC
27713-8004
US

V. Phone/Fax

Practice location:
  • Phone: 336-227-0590
  • Fax:
Mailing address:
  • Phone: 401-741-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number9129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: