Healthcare Provider Details

I. General information

NPI: 1033543582
Provider Name (Legal Business Name): PATRICIA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2013
Last Update Date: 09/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 SPARROWS NEST LN
PINEVILLE NC
28134-8846
US

IV. Provider business mailing address

915 SPARROWS NEST LN
PINEVILLE NC
28134-8846
US

V. Phone/Fax

Practice location:
  • Phone: 704-621-9695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number8703
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: