Provider Demographics
NPI:1205557899
Name:MCNAMARA, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 WALKING HORSE CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7444
Mailing Address - Country:US
Mailing Address - Phone:630-414-5648
Mailing Address - Fax:
Practice Address - Street 1:7429 WALKING HORSE CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7444
Practice Address - Country:US
Practice Address - Phone:630-414-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist