Provider Demographics
NPI:1588297204
Name:YINGLING, MARY ALLISON
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALLISON
Last Name:YINGLING
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 1:1331 ABINGDON WAY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4429
Mailing Address - Country:US
Mailing Address - Phone:336-416-5820
Mailing Address - Fax:
Practice Address - Street 1:1331 ABINGDON WAY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4429
Practice Address - Country:US
Practice Address - Phone:336-416-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13083225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics