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Individual

MISS KEIRA JEAN GATHERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.O.T.

Contact information

Practice address
3007 SIMMON TREE RD, CHARLOTTE, NC 28270-0676
(704) 995-2900
Mailing address
2028 GALTY LN, CHARLOTTE, NC 28270-1147
(980) 322-2185

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
618
HI
225XP0200X
Pediatric Occupational Therapist
Primary
7155
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7302220
NC
Enumeration date
01/30/2007
Last updated
12/31/2014
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