Healthcare Provider Details

I. General information

NPI: 1518413293
Provider Name (Legal Business Name): JANICE WHITLEY OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 J M KEYNES DR STE 290
CHARLOTTE NC
28262-8436
US

IV. Provider business mailing address

5043 TUCKER AVE
KANNAPOLIS NC
28081-7418
US

V. Phone/Fax

Practice location:
  • Phone: 704-423-9449
  • Fax: 704-423-9455
Mailing address:
  • Phone: 980-521-7097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number4474
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: