Provider Demographics
NPI:1609426212
Name:MUMFORD, SAVANNAH GRAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:GRAY
Last Name:MUMFORD
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 1:514 BAY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-9094
Mailing Address - Country:US
Mailing Address - Phone:252-402-6160
Mailing Address - Fax:
Practice Address - Street 1:1540 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5870
Practice Address - Country:US
Practice Address - Phone:252-364-2806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12825225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist