Provider Demographics
NPI:1932796802
Name:MCLAWHORN, BRIANNA NICOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
Last Name:MCLAWHORN
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 1:7563 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:SIMS
Mailing Address - State:NC
Mailing Address - Zip Code:27880-9629
Mailing Address - Country:US
Mailing Address - Phone:252-281-8214
Mailing Address - Fax:
Practice Address - Street 1:403 CRESTVIEW AVE SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4505
Practice Address - Country:US
Practice Address - Phone:252-237-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13221224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant