Individual
JUANITA ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2727 SHAMROCK DR, 2727 SHAMROCK DRIVE, CHARLOTTE, NC 28205-2215
(704) 563-0886
(704) 563-9731
Mailing address
2727 SHAMROCK DR, 2727 SHAMROCK DRIVE, CHARLOTTE, NC 28205-2215
(704) 563-0886
(704) 563-9731
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6143
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386764249
—
NC
Enumeration date
04/05/2017
Last updated
04/05/2017
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