Healthcare Provider Details

I. General information

NPI: 1669209953
Provider Name (Legal Business Name): JOSEPH WOJCIECHOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SMALL COUNTRY LN
MIDLAND NC
28107-7239
US

IV. Provider business mailing address

601 SMALL COUNTRY LN
MIDLAND NC
28107-7239
US

V. Phone/Fax

Practice location:
  • Phone: 704-771-0051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7984
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: