Healthcare Provider Details

I. General information

NPI: 1932535838
Provider Name (Legal Business Name): AUDREY NOWLIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W MAIN ST
YADKINVILLE NC
27055-7807
US

IV. Provider business mailing address

3001 SPRING FOREST RD
RALEIGH NC
27616-2815
US

V. Phone/Fax

Practice location:
  • Phone: 336-679-8863
  • Fax:
Mailing address:
  • Phone: 919-424-5086
  • Fax: 919-424-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8901
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: