1568832707 NPI number — MRS. NATALIE FUTRELL SHORE OTR/L

Table of content: MRS. NATALIE FUTRELL SHORE OTR/L (NPI 1568832707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568832707 NPI number — MRS. NATALIE FUTRELL SHORE OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHORE
Provider First Name:
NATALIE
Provider Middle Name:
FUTRELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUTRELL
Provider Other First Name:
NATALIE
Provider Other Middle Name:
ANN
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:
1568832707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1229 TOTEROS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXHAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28173-6950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-649-4509
Provider Business Mailing Address Fax Number:
704-843-9045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 KENILWORTH AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-3874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-649-4509
Provider Business Practice Location Address Fax Number:
704-843-9045
Provider Enumeration Date:
09/30/2015

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:  9979 , 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)





Copyright © 2007-2025 www.npivalidator.com