Provider Demographics
NPI:1164112694
Name:SHIMER, GRETCHEN YVONNE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:YVONNE
Last Name:SHIMER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ELDERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-6369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 ELDERBERRY LN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6369
Practice Address - Country:US
Practice Address - Phone:828-649-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist