Provider Demographics
NPI:1326202201
Name:SECURA, CYNTHIA C (COTA/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:SECURA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 HULSEY RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-7658
Mailing Address - Country:US
Mailing Address - Phone:910-947-3549
Mailing Address - Fax:
Practice Address - Street 1:316 HULSEY RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-7658
Practice Address - Country:US
Practice Address - Phone:910-947-3549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2609224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2609OtherCERTIFIED OCCUPATIONAL THERAPY ASSISTANT LICENSE NUMBER