Healthcare Provider Details

I. General information

NPI: 1780250274
Provider Name (Legal Business Name): LAURYN ELEANOR JEAN BEWLAY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 LEXINGTON COMMONS DR
ROCK HILL SC
29732-3528
US

IV. Provider business mailing address

119 S FARNLEIGH DR
CHAPEL HILL NC
27517-7476
US

V. Phone/Fax

Practice location:
  • Phone: 803-207-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14501
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6178
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: