Provider Demographics
NPI:1821462961
Name:WAKEFORD, CONSTANCE (OT/L)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:WAKEFORD
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S COLUMBIA ST
Mailing Address - Street 2:BONDURANT HALL SUITE 2050
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7122
Mailing Address - Country:US
Mailing Address - Phone:919-843-4464
Mailing Address - Fax:919-966-9007
Practice Address - Street 1:321 S COLUMBIA ST
Practice Address - Street 2:BONDURANT HALL SUITE 2050
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7122
Practice Address - Country:US
Practice Address - Phone:919-843-4464
Practice Address - Fax:919-966-9007
Is Sole Proprietor?:No
Enumeration Date:2015-11-29
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC543225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics