Healthcare Provider Details

I. General information

NPI: 1841571049
Provider Name (Legal Business Name): DESTINI HARDY-STOVER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27835
US

IV. Provider business mailing address

2100 STANTONSBURG ROAD
GREENVILLE NC
27835
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number6880
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: