Provider Demographics
NPI:1104085802
Name:HORNBUCKLE, ANNIE LENORA (OTR)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:LENORA
Last Name:HORNBUCKLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LYNN WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4757
Mailing Address - Country:US
Mailing Address - Phone:828-403-6659
Mailing Address - Fax:
Practice Address - Street 1:202 LYNN WOOD ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4757
Practice Address - Country:US
Practice Address - Phone:828-403-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist