Healthcare Provider Details

I. General information

NPI: 1760197586
Provider Name (Legal Business Name): EUGENIA GIANCARLO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 RANDOLPH RD STE 109
CHARLOTTE NC
28211-1086
US

IV. Provider business mailing address

704 WILBROWN CIR
CHARLOTTE NC
28217-2510
US

V. Phone/Fax

Practice location:
  • Phone: 570-640-6282
  • Fax:
Mailing address:
  • Phone: 570-640-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15657
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: