Provider Demographics
NPI:1659420040
Name:RICHARDS, LINNETTE A (OTAL)
Entity Type:Individual
Prefix:MS
First Name:LINNETTE
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:OTAL
Other - Prefix:
Other - First Name:LINNETTE
Other - Middle Name:
Other - Last Name:WHITCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:484 WILLIAMSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8191
Mailing Address - Country:US
Mailing Address - Phone:704-746-9698
Mailing Address - Fax:
Practice Address - Street 1:364 S HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-8702
Practice Address - Country:US
Practice Address - Phone:704-746-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3797225X00000X
NC9032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0853542084OtherTRICARE
FL11184701OtherCITRUS HMO
FL2081FOtherBCBS
FL890197000Medicaid