Provider Demographics
NPI:1649479122
Name:REID, MIRIAM L (OTR/L, LMBT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:L
Last Name:REID
Suffix:
Gender:F
Credentials:OTR/L, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E CHATHAM ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3495
Mailing Address - Country:US
Mailing Address - Phone:919-466-9494
Mailing Address - Fax:919-557-3887
Practice Address - Street 1:216 E CHATHAM ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3495
Practice Address - Country:US
Practice Address - Phone:919-466-9494
Practice Address - Fax:919-557-3887
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1245225700000X
NC1230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist