Provider Demographics
NPI:1073062865
Name:SELL, GARAHETTA ROBIN
Entity Type:Individual
Prefix:MISS
First Name:GARAHETTA
Middle Name:ROBIN
Last Name:SELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WEST END DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112
Mailing Address - Country:US
Mailing Address - Phone:704-698-7401
Mailing Address - Fax:
Practice Address - Street 1:600 WEST END DRIVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112
Practice Address - Country:US
Practice Address - Phone:704-698-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7562225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist