Individual
MR. DEAN WIDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, OTR/L
Contact information
Practice address
105 CANTERSTONE CT, CARY, NC 27518-2251
(919) 815-4389
Mailing address
105 CANTERSTONE CT, CARY, NC 27518-2251
(919) 815-4389
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
4143
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
154V6
BLUECROSS BLUESHIELD OF NORTH CAROLINA
NC
05
—
7302150
—
NC
Enumeration date
01/16/2007
Last updated
06/23/2010
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