Healthcare Provider Details

I. General information

NPI: 1699401653
Provider Name (Legal Business Name): AMONTAE NICOLE PERKINS DOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 PARK RD STE 200
CHARLOTTE NC
28209-2378
US

IV. Provider business mailing address

4012 PARK RD STE 200
CHARLOTTE NC
28209-2378
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-4834
  • Fax: 704-372-9653
Mailing address:
  • Phone: 704-332-4834
  • Fax: 704-372-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15251
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: