Individual
TEQUILA BREYONDA PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
16 2ND ST NW, HICKORY, NC 28601-6105
(828) 358-0976
(828) 838-1057
Mailing address
PO BOX 749, BELMONT, NC 28012-0749
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
16408
NC
Other
Enumeration date
11/28/2023
Last updated
05/30/2024
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