Provider Demographics
NPI:1689000770
Name:LANE, PATRICIA HOLYFIELD (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:HOLYFIELD
Last Name:LANE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 BRENNAN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1312
Mailing Address - Country:US
Mailing Address - Phone:919-247-4031
Mailing Address - Fax:
Practice Address - Street 1:304 JUDD PLACE DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2386
Practice Address - Country:US
Practice Address - Phone:919-557-8305
Practice Address - Fax:919-557-8306
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist