Provider Demographics
NPI:1073378048
Name:HOSMER, MICHAYLA LEE
Entity Type:Individual
Prefix:
First Name:MICHAYLA
Middle Name:LEE
Last Name:HOSMER
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 1:58 PHYSICIANS DR NW STE 106
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4216
Mailing Address - Country:US
Mailing Address - Phone:910-755-5437
Mailing Address - Fax:910-755-6076
Practice Address - Street 1:58 PHYSICIANS DR NW STE 106
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4216
Practice Address - Country:US
Practice Address - Phone:910-755-5437
Practice Address - Fax:910-755-6076
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist