Organization
LEGACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONNIE FAYE HUMMER-WHEELER COTA (CERTIFIED OCCUPATIONAL THERAPIST)
(910) 964-4764
Entity
Organization
Contact information
Practice address
3001 SPRING FOREST RD, RALEIGH, NC 27616-2815
(919) 424-5086
(919) 424-5085
Mailing address
3001SPRING FOREST ROAD, RALIEGH, NC 27616
(919) 424-5086
(919) 424-5085
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
5760
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25000000
—
NC
Enumeration date
05/06/2014
Last updated
05/06/2014
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