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NPI Code Detail

MEDICARE: KELLY LAWLER WEYNAND OTR/L

MEDICARE: KELLY LAWLER WEYNAND 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
1225XP0200XPediatric Occupational Therapist11333NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000034225830OTHERNCDRIVERS LICENSE

General Provider Information

NPI Number : 1235647215
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LAWLER WEYNAND OTR/L
Provider Business Mailing Address
First Line : 9611 BROOKDALE DR STE 100-122
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-8719
Country : US
Telephone Number : 704-807-5699
Fax Number :
Provider Business Practice Location Address
First Line : 1016 EUCLID AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-4520
Country : US
Telephone Number : 704-807-5699
Fax Number : 704-807-5699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2018
Last Update Date : 01/12/2018

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Directions to “ KELLY LAWLER WEYNAND OTR/L” Practice Location

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