Basic Information
| Provider Information | |||||||||
| NPI: | 1033860853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANKER | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645616946 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 S GREENE ST. | ||||||||
| Address2: | |||||||||
| City: | WADESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046953301 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2022 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 13926 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.