Healthcare Provider Details

I. General information

NPI: 1205867157
Provider Name (Legal Business Name): VIRENDER KUMARI GAUTAM OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6590 TRYON RD
CARY NC
27518-7052
US

IV. Provider business mailing address

717 TOULOUSE CT
CARY NC
27519-6754
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-5311
  • Fax:
Mailing address:
  • Phone: 509-431-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number3389
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: