Individual
SCOTILLIA NOEL FOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
401 IRVING PKWY, HOLLY SPRINGS, NC 27540-5300
(919) 793-3396
Mailing address
PO BOX 142, WAKE FOREST, NC 27588-0142
(919) 793-3396
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
115635
TX
225X00000X
Occupational Therapist
8544
NC
225XH1200X
Hand Occupational Therapist
—
—
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
8544
NC
225XP0019X
Physical Rehabilitation Occupational Therapist
8544
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q49100E346
MEDICARE PTAN
NC
Enumeration date
01/03/2014
Last updated
12/05/2022
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