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General NPI Number Information
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NPI Number | 1033392717
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Entity Type | Individual
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Provider Name | MARY L BAYSDON CFOM CFTS
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Gender | Female
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 480 E 9TH ST
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City | LUMBERTON
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State | NC
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Zip | 28358-4880
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Country | US
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Telephone | 910-272-9900
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Fax | 910-671-1983
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Provider Business Mailing Address
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Address Line | PO BOX 3576
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City | LUMBERTON
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State | NC
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Zip | 28359-3576
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Country | US
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Telephone | 910-272-9900
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Fax | 910-671-1983
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CFOM0662
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CFTS0275
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License Number State | NC
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