Individual
PENELOPE NOELL FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3420 HOLLOWAY ST, DURHAM, NC 27703-3522
(919) 596-9464
Mailing address
4308 ABBEY PL, DURHAM, NC 27707-5601
(919) 971-3194
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11161
NC
Other
Enumeration date
10/12/2017
Last updated
10/12/2017
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