Basic Information
| Provider Information | |||||||||
| NPI: | 1952736498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NESBITT | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | HUDSON | ||||||||
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| Credential: | COTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 COBBLEPOINT WAY | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275408257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193065286 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 SPRING FOREST RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276099150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198768899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2013 | ||||||||
| LastUpdateDate: | 09/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 4586 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.