Provider Demographics
NPI:1982297115
Name:CEDILLO, NATALIE TORRES (OTR/L)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:TORRES
Last Name:CEDILLO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 BRIDAL CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2069
Mailing Address - Country:US
Mailing Address - Phone:336-995-8376
Mailing Address - Fax:
Practice Address - Street 1:2500 POLO RIDGE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3950
Practice Address - Country:US
Practice Address - Phone:336-774-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28773215OtherDRIVER LICENSE
NC11882OtherOCCUPATIONAL THERAPY LICENSE