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NPI Code Detail

MEDICARE: MRS. MENDY ANNETTE BAXTER MS OTRL

MEDICARE: MRS. MENDY ANNETTE BAXTER MS OTRL
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 Therapist4882NC

General Provider Information

NPI Number : 1649326455
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MENDY ANNETTE BAXTER MS OTRL
Provider Business Mailing Address
First Line : 3906 HERMES LN
Second Line :
City : WAXHAW
State : NC
Zip : 28173-7879
Country : US
Telephone Number : 704-839-1814
Fax Number :
Provider Business Practice Location Address
First Line : 5700 EXECUTIVE CENTER DR
Second Line : SUITE 110
City : CHARLOTTE
State : NC
Zip : 28212-8858
Country : US
Telephone Number : 704-566-6040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 07/08/2007

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