Provider Demographics
NPI:1568832707
Name:SHORE, NATALIE FUTRELL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:FUTRELL
Last Name:SHORE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:ANN
Other - Last Name:FUTRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1229 TOTEROS DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6950
Mailing Address - Country:US
Mailing Address - Phone:704-649-4509
Mailing Address - Fax:704-843-9045
Practice Address - Street 1:741 KENILWORTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3874
Practice Address - Country:US
Practice Address - Phone:704-649-4509
Practice Address - Fax:704-843-9045
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist