Provider Demographics
NPI:1790847457
Name:WOLFE, ALAN E (MS OTR L)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:E
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 691775
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7030
Mailing Address - Country:US
Mailing Address - Phone:704-771-0051
Mailing Address - Fax:800-806-9071
Practice Address - Street 1:12970 SW 117TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4611
Practice Address - Country:US
Practice Address - Phone:704-771-0051
Practice Address - Fax:800-806-9071
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 4720225X00000X
NC5989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301918Medicaid