1003107061 NPI number — MS. LUCINDA VARN COLLINS

Table of content: MS. LUCINDA VARN COLLINS (NPI 1003107061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003107061 NPI number — MS. LUCINDA VARN COLLINS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
LUCINDA
Provider Middle Name:
VARN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VARN
Provider Other First Name:
LUCINDA
Provider Other Middle Name:
MAREE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003107061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 S FIFTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEBANE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27302-2707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-563-2369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1987 HILTON RD
Provider Second Line Business Practice Location Address:
ALAMANCE HEALTH CARE CENTER
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-226-0848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  0984 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0984 . This is a "OCCUPATIONAL THERAPY NC LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".