Provider Demographics
NPI:1720245483
Name:STROUD, RAGINA PETERSON (COTA/L)
Entity Type:Individual
Prefix:
First Name:RAGINA
Middle Name:PETERSON
Last Name:STROUD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 JOE NUNN RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7746
Mailing Address - Country:US
Mailing Address - Phone:252-523-0106
Mailing Address - Fax:
Practice Address - Street 1:907 CUNNINGHAM RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1825
Practice Address - Country:US
Practice Address - Phone:252-520-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3350224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant