Provider Demographics
NPI:1649326455
Name:BAXTER, MENDY ANNETTE (MS OTRL)
Entity type:Individual
Prefix:MRS
First Name:MENDY
Middle Name:ANNETTE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:MENDY
Other - Middle Name:ANNETTE
Other - Last Name:LOWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3906 HERMES LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7879
Mailing Address - Country:US
Mailing Address - Phone:704-839-1814
Mailing Address - Fax:
Practice Address - Street 1:5700 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8858
Practice Address - Country:US
Practice Address - Phone:704-566-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4882225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics