Provider Demographics
NPI:1568585412
Name:MINGUS, TRINA (OT)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:MINGUS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SCOTTY CT
Mailing Address - Street 2:
Mailing Address - City:CRAMERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28032-1656
Mailing Address - Country:US
Mailing Address - Phone:704-824-9865
Mailing Address - Fax:
Practice Address - Street 1:808 SCOTTY CT
Practice Address - Street 2:
Practice Address - City:CRAMERTON
Practice Address - State:NC
Practice Address - Zip Code:28032-1656
Practice Address - Country:US
Practice Address - Phone:704-824-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2399225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist