Healthcare Provider Details

I. General information

NPI: 1871557504
Provider Name (Legal Business Name): BRENDA M LINGLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

6825 US HIGHWAY 52
SALISBURY NC
28146-8953
US

V. Phone/Fax

Practice location:
  • Phone: 704-638-9000
  • Fax: 704-638-3364
Mailing address:
  • Phone: 704-279-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2428
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: