Provider Demographics
NPI:1558017129
Name:PARRISH, LILLIAN JOHN (OTD)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:JOHN
Last Name:PARRISH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 GORDON RD STE H
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8424
Mailing Address - Country:US
Mailing Address - Phone:910-233-0726
Mailing Address - Fax:
Practice Address - Street 1:6626 GORDON RD STE H
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8424
Practice Address - Country:US
Practice Address - Phone:910-798-4051
Practice Address - Fax:910-338-0424
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14670OtherNORTH CAROLINA LICENSE