Provider Demographics
NPI:1114359296
Name:PETERSON, NANCY MCNEILL (OT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MCNEILL
Last Name:PETERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4610 HOLLY TREE RD
Practice Address - Street 2:304
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-8556
Practice Address - Country:US
Practice Address - Phone:910-859-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist