Provider Demographics
NPI:1508642687
Name:SHEETS, LARAMIE
Entity Type:Individual
Prefix:
First Name:LARAMIE
Middle Name:
Last Name:SHEETS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 ASHE CENTRAL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-8988
Mailing Address - Country:US
Mailing Address - Phone:828-768-4422
Mailing Address - Fax:
Practice Address - Street 1:103 CLIFTON ST UNIT A
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2719
Practice Address - Country:US
Practice Address - Phone:336-829-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist