Healthcare Provider Details

I. General information

NPI: 1013247428
Provider Name (Legal Business Name): MARCIE HESLOP SIEBERT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIE A HESLOP

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 RANDOLPH RD FL 2
CHARLOTTE NC
28207-1101
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2000
  • Fax:
Mailing address:
  • Phone: 704-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9688
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6267
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7097
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: