Healthcare Provider Details

I. General information

NPI: 1073417622
Provider Name (Legal Business Name): ANNA GRACE LOCKEY MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2092 AYRSLEY TOWN BLVD
CHARLOTTE NC
28273-4037
US

IV. Provider business mailing address

5852 TIPPERARY DR
DENVER NC
28037-7676
US

V. Phone/Fax

Practice location:
  • Phone: 704-577-4094
  • Fax:
Mailing address:
  • Phone: 704-240-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18222
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: