Individual
MARY GRACE VILLANUEVA-BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4015 CHEEK ROAD, DURHAM, NC 27704-4905
(919) 428-0931
Mailing address
4015 CHEEK ROAD, DURHAM, NC 27704-4905
(919) 428-0931
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5889
NC
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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