Provider Demographics
NPI:1124659131
Name:FESPERMAN, SIERA DAWN
Entity type:Individual
Prefix:
First Name:SIERA
Middle Name:DAWN
Last Name:FESPERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 BENTLEY CT
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-6529
Mailing Address - Country:US
Mailing Address - Phone:980-234-4243
Mailing Address - Fax:
Practice Address - Street 1:1002 BENTLEY CT
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-6529
Practice Address - Country:US
Practice Address - Phone:980-234-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer