Provider Demographics
NPI:1952859613
Name:FENTRESS, CLARE LOUISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:LOUISE
Last Name:FENTRESS
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 1:1064 COACHMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-6158
Mailing Address - Country:US
Mailing Address - Phone:919-219-6286
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:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist