Individual
AMIQUE AMOY WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4615 UNIVERSITY DR, DURHAM, NC 27707-3458
(188) 835-1828
Mailing address
4615 UNIVERSITY DR, DURHAM, NC 27707-3458
(188) 835-1828
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UUI103212601
NORTH CAROLINA STUDENT BLUE
NC
Enumeration date
02/17/2022
Last updated
02/17/2022
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