Basic Information
| Provider Information | |||||||||
| NPI: | 1982365284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESTY | ||||||||
| FirstName: | HILAIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3757 WAKEFIELD LN | ||||||||
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| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275299386 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6590 TRYON RD | ||||||||
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| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198518000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2022 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 10690 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.