Provider Demographics
NPI:1497536395
Name:TYNDALL, MARY GRACE (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 PIPER FARM RD APT 19
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6603
Mailing Address - Country:US
Mailing Address - Phone:336-520-4707
Mailing Address - Fax:
Practice Address - Street 1:550 BAILEY RD STE 401
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2424
Practice Address - Country:US
Practice Address - Phone:910-674-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16369225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist