Provider Demographics
NPI:1295077725
Name:PHELPS, EMILOU GRAY (CFTS)
Entity type:Individual
Prefix:
First Name:EMILOU
Middle Name:GRAY
Last Name:PHELPS
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 US HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9593
Mailing Address - Country:US
Mailing Address - Phone:252-793-9036
Mailing Address - Fax:252-793-1006
Practice Address - Street 1:454 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9593
Practice Address - Country:US
Practice Address - Phone:252-793-9036
Practice Address - Fax:252-793-1006
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies