Provider Demographics
NPI:1528352218
Name:DEFOREST, MARY MARGARET (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARY MARGARET
Middle Name:
Last Name:DEFOREST
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 1:5725 OLEANDER DR STE F3
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4747
Mailing Address - Country:US
Mailing Address - Phone:910-313-2111
Mailing Address - Fax:910-313-2119
Practice Address - Street 1:5725 OLEANDER DR STE F3
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4747
Practice Address - Country:US
Practice Address - Phone:910-313-2111
Practice Address - Fax:910-313-2119
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6071225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics