Provider Demographics
NPI:1952030496
Name:DENUNZIO, HALLIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:DENUNZIO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 W MOORE ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3537
Mailing Address - Country:US
Mailing Address - Phone:336-916-2106
Mailing Address - Fax:336-639-7200
Practice Address - Street 1:554 W MOORE ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3537
Practice Address - Country:US
Practice Address - Phone:336-916-2106
Practice Address - Fax:336-639-7200
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14852225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
468922OtherNBCOT
NC14852OtherNCBOT