Healthcare Provider Details

I. General information

NPI: 1447720990
Provider Name (Legal Business Name): QUENICIA NOBLES STARKS MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 RAMSEY ST
FAYETTEVILLE NC
28301-3856
US

IV. Provider business mailing address

1901 ROBERT LUKE DR NE
LELAND NC
28451-9297
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2021
  • Fax:
Mailing address:
  • Phone: 252-876-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number10796
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: