Individual
JACQUELYN MARIE BINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, R/L
Contact information
Practice address
604 LUCAS RD, DUNN, NC 28334-6623
(910) 891-4600
Mailing address
4451 VILANA RDG APT 403, RALEIGH, NC 27612-4681
(484) 723-3258
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14569
NORTH CAROLINA BOARD OF OCCUPATIONAL THERAPY
NC
Enumeration date
10/04/2021
Last updated
11/28/2021
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