Individual
MRS. MARIE ADELFA FULLER ZURENDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1009 FLAMELEAF CT, LEWISVILLE, NC 27023-8611
(786) 217-7544
(336) 776-0099
Mailing address
1305 LYN DR, BLACKFOOT, ID 83221-3661
(406) 521-0052
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2002
ID
224Z00000X
Occupational Therapy Assistant
9318
NC
224Z00000X
Occupational Therapy Assistant
OTA13777
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7118
—
NC
Enumeration date
07/14/2014
Last updated
03/18/2019
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