Provider Demographics
NPI:1083344261
Name:MAINGUY KREMER, KARLY DAVIS
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:DAVIS
Last Name:MAINGUY KREMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLY
Other - Middle Name:DAVIS
Other - Last Name:MAINGUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:205 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-0197
Mailing Address - Country:US
Mailing Address - Phone:828-557-3775
Mailing Address - Fax:
Practice Address - Street 1:811 SNOWBIRD RD
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-8103
Practice Address - Country:US
Practice Address - Phone:828-479-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14290224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant