Individual
KIMBERLY GRAY MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
7209 CREEDMOOR RD, SUITE 101, RALEIGH, NC 27613-1625
(919) 844-1100
Mailing address
11725 STANNARY PL, RALEIGH, NC 27613-7814
(352) 682-8996
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
6619
NC
Other
Enumeration date
09/26/2007
Last updated
12/13/2007
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