Healthcare Provider Details

I. General information

NPI: 1679430938
Provider Name (Legal Business Name): COREY STEPHEN SOSSAMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12199 COYLE RD
STANFIELD NC
28163-9760
US

IV. Provider business mailing address

12199 COYLE RD
STANFIELD NC
28163-9760
US

V. Phone/Fax

Practice location:
  • Phone: 704-701-2269
  • Fax:
Mailing address:
  • Phone: 704-701-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number18127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: