Provider Demographics
NPI:1114561313
Name:MORANTE LARRAIN, PAULA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MORANTE LARRAIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 SOUTHERN OAKS DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1258
Mailing Address - Country:US
Mailing Address - Phone:305-766-7647
Mailing Address - Fax:
Practice Address - Street 1:1555 CAIN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3078
Practice Address - Country:US
Practice Address - Phone:910-423-5622
Practice Address - Fax:910-378-1755
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007029225X00000X
FL19034225X00000X
NC12505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist