Provider Demographics
NPI:1063979300
Name:FAIR, JAIME CARLISLE (OTR/L)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:CARLISLE
Last Name:FAIR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4834 CROCKETT CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-6304
Mailing Address - Country:US
Mailing Address - Phone:919-357-2551
Mailing Address - Fax:
Practice Address - Street 1:4834 CROCKETT CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-6304
Practice Address - Country:US
Practice Address - Phone:919-357-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12064225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist