Individual
MRS. GRACE SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
10508 PARK RD, SUITE 130, CHARLOTTE, NC 28210-8525
(704) 541-9080
(704) 542-0699
Mailing address
5252 LAKE WYLIE RD, LAKE WYLIE, SC 29710-9181
(803) 412-7104
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
3233
SC
225X00000X
Occupational Therapist
6575
NC
225XP0200X
Pediatric Occupational Therapist
Primary
6575
NC
Other
Enumeration date
03/23/2007
Last updated
09/14/2009
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