Individual
AMANDA GRACE CEDILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
4201 LAKE BOONE TRAIL, SUITE 4, RALEIGH, NC 27607-7511
(919) 781-4434
(919) 781-5851
Mailing address
4201 LAKE BOONE TRAIL, SUITE 4, RALEIGH, NC 27607-7511
(919) 781-4434
(919) 781-5851
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
225X00000X
Occupational Therapist
Primary
5919
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1413T
BCBS
—
01
—
187639
MEDCOST
—
01
—
6400040
UNITED HEATHCARE
—
05
—
7301902
—
NC
01
—
7404775
AETNA
—
05
—
8300041K
—
NC
Enumeration date
12/26/2006
Last updated
06/06/2008
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