Provider Demographics
NPI:1316405335
Name:O'CONNOR, JUSTINE ROCHELLE (SLP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ROCHELLE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:SLP
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 2417
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-2417
Mailing Address - Country:US
Mailing Address - Phone:252-355-5535
Mailing Address - Fax:252-355-5536
Practice Address - Street 1:300 E ARLINGTON BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5024
Practice Address - Country:US
Practice Address - Phone:252-355-5535
Practice Address - Fax:252-355-5536
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist