Provider Demographics
NPI:1093971699
Name:FITZGERALD, SINDY WYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:SINDY
Middle Name:WYNN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 SMITHWICK CREEK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-7637
Mailing Address - Country:US
Mailing Address - Phone:252-792-7582
Mailing Address - Fax:
Practice Address - Street 1:100 HICKORY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-1674
Practice Address - Country:US
Practice Address - Phone:252-830-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6205224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant