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General NPI Number Information
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NPI Number | 1144115569
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Entity Type | Individual
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Provider Name | MCRAE JIMENEZ OT/L
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2300 GALLBERRY LN
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City | WAXHAW
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State | NC
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Zip | 28173-0161
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Country | US
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Telephone | 704-843-9045
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 SUNSET AVE
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City | DURHAM
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State | NC
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Zip | 27705-3257
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Country | US
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Telephone | 843-810-5600
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Fax |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17652
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License Number State | NC
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