Provider Demographics
NPI:1831524479
Name:MCLAURIN, AMY D (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:D
Last Name:MCLAURIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4496 COLLIER RD
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-8876
Mailing Address - Country:US
Mailing Address - Phone:910-920-6204
Mailing Address - Fax:
Practice Address - Street 1:4496 COLLIER RD
Practice Address - Street 2:
Practice Address - City:WADE
Practice Address - State:NC
Practice Address - Zip Code:28395-8876
Practice Address - Country:US
Practice Address - Phone:910-920-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5074172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker