Provider Demographics
NPI:1043286321
Name:PATE, MARJORIE COY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:COY
Last Name:PATE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-0362
Mailing Address - Country:US
Mailing Address - Phone:919-739-0047
Mailing Address - Fax:919-739-9041
Practice Address - Street 1:600 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3143
Practice Address - Country:US
Practice Address - Phone:919-739-0047
Practice Address - Fax:919-739-9041
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC65842OtherBCBS INDIVIDUAL
NC7365842Medicaid