Healthcare Provider Details

I. General information

NPI: 1477203172
Provider Name (Legal Business Name): MRS. KIRSTEN HENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CORNING RD
CARY NC
27518-9229
US

IV. Provider business mailing address

1201 PINE HAVEN DR APT 5313
RALEIGH NC
27607-6108
US

V. Phone/Fax

Practice location:
  • Phone: 919-431-7400
  • Fax:
Mailing address:
  • Phone: 540-808-7305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119010238
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16967
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: