Provider Demographics
NPI:1417978529
Name:FAISON, TOMEICO L (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TOMEICO
Middle Name:L
Last Name:FAISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3834
Mailing Address - Country:US
Mailing Address - Phone:919-451-0313
Mailing Address - Fax:919-562-9441
Practice Address - Street 1:1103 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3834
Practice Address - Country:US
Practice Address - Phone:919-451-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4761OtherPROFESSIONAL OT LICENSE