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General NPI Number Information
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NPI Number | 1437952124
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Entity Type | Individual
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Provider Name | MARY CECILIA GARDNER OT/L
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Gender | Female
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Dates
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Enumeration Date | 03/29/2025
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 12427 SWAN WINGS PL
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-2342
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Country | US
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Telephone | 704-956-3417
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Fax | 704-956-3417
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Provider Business Mailing Address
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Address Line | 12427 SWAN WINGS PL
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-2342
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Country | US
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Telephone | 704-956-3417
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Fax | 704-956-3417
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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 | 6239
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License Number State | NC
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