MEDICARE: MRS. CAMILLA LESLIE MCRAE 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
1	225X00000X	Occupational Therapist	1666	NC

General Provider Information

NPI Number	:	1376611897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMILLA LESLIE MCRAE OTR/L

Provider Business Mailing Address
First Line	:	1017 CROSS GATE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-6324
Country	:	US
Telephone Number	:	769-216-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 CROSS GATE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-6324
Country	:	US
Telephone Number	:	769-216-7006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	12/09/2025

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