Healthcare Provider Details

I. General information

NPI: 1043850019
Provider Name (Legal Business Name): EMILY MINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N TRADD ST
STATESVILLE NC
28677-5239
US

IV. Provider business mailing address

129 N TRADD ST
STATESVILLE NC
28677-5239
US

V. Phone/Fax

Practice location:
  • Phone: 704-380-0799
  • Fax: 704-380-0799
Mailing address:
  • Phone: 704-380-0799
  • Fax: 704-380-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12956
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: