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NPI Code Detail

MEDICARE: RAYDESHA BANKS OTR/L

MEDICARE: RAYDESHA BANKS OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist11557NC

General Provider Information

NPI Number : 1114429321
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYDESHA BANKS OTR/L
Provider Business Mailing Address
First Line : 4621 BAY CREEK DR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-9422
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 849 WATERWORKS RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27101-1956
Country : US
Telephone Number : 336-595-2166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2018
Last Update Date : 03/17/2018

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Directions to “ RAYDESHA BANKS OTR/L” Practice Location

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