Provider Demographics
NPI:1114209111
Name:HOMESLEY, ROGER CLEVELAND (CFO CFTS)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:CLEVELAND
Last Name:HOMESLEY
Suffix:
Gender:M
Credentials:CFO CFTS
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 368
Mailing Address - Street 2:626 CENTER DRIVE
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093-0368
Mailing Address - Country:US
Mailing Address - Phone:704-735-2556
Mailing Address - Fax:704-735-9045
Practice Address - Street 1:626 CENTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3712
Practice Address - Country:US
Practice Address - Phone:704-735-2556
Practice Address - Fax:704-735-9045
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFO 03634225000000X
NCCFTS 1242225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter