Provider Demographics
NPI:1114195609
Name:SILVER, JEANETTE (OT/L)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:SILVER
Suffix:
Gender:F
Credentials:OT/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 2061
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-2061
Mailing Address - Country:US
Mailing Address - Phone:336-681-4742
Mailing Address - Fax:888-582-5670
Practice Address - Street 1:104 CARMEL CT
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2477
Practice Address - Country:US
Practice Address - Phone:336-681-4742
Practice Address - Fax:888-582-5670
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4696225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC148A7OtherBLUE CROSS BLUE SHIELD
NC7302077Medicaid