Provider Demographics
NPI:1700389657
Name:RAINES, TAYLOR KATHRYN (CFO)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KATHRYN
Last Name:RAINES
Suffix:
Gender:F
Credentials:CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PAGE RD N STE 3
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-0088
Mailing Address - Country:US
Mailing Address - Phone:910-295-2828
Mailing Address - Fax:
Practice Address - Street 1:325 PAGE RD N STE 3
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-0088
Practice Address - Country:US
Practice Address - Phone:910-295-2828
Practice Address - Fax:910-295-2996
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFO04457225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter