Provider Demographics
NPI:1124037353
Name:PORTER, MARGARET GRAYSON (OTRL)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:GRAYSON
Last Name:PORTER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-2843
Mailing Address - Country:US
Mailing Address - Phone:336-207-8957
Mailing Address - Fax:336-886-1247
Practice Address - Street 1:110 SCOTT AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7834
Practice Address - Country:US
Practice Address - Phone:336-207-8957
Practice Address - Fax:336-886-1247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4601225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301625Medicaid