Individual
MRS. SANDRA SKELLIE BRUNS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
4201 LAKE BOONE TRL STE 4, RALEIGH, NC 27607-7511
(919) 781-4434
Mailing address
307 VINCA CIR, CARY, NC 27513-5755
(828) 273-1334
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0022
NC
225XP0200X
Pediatric Occupational Therapist
0022
NC
225XP0200X
Pediatric Occupational Therapist
22
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1426Y
BCBSNC
NC
01
—
190695
MEDCOST
NC
05
—
7301925
—
NC
Enumeration date
09/28/2006
Last updated
09/24/2024
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