Provider Demographics
NPI:1346875671
Name:FETTY, LAURYN (MOT)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:FETTY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 FERGUSON COVE LOOP
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8361
Mailing Address - Country:US
Mailing Address - Phone:352-812-0059
Mailing Address - Fax:
Practice Address - Street 1:856 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1547
Practice Address - Country:US
Practice Address - Phone:828-684-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12599225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty