Provider Demographics
NPI:1891033692
Name:KING, NANCY E (MS, OT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HORSETRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4604
Mailing Address - Country:US
Mailing Address - Phone:845-417-4646
Mailing Address - Fax:
Practice Address - Street 1:905 HORSETRAIL WAY
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4604
Practice Address - Country:US
Practice Address - Phone:845-417-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011593-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist