Provider Demographics
NPI:1679779631
Name:TRAYLOR, BRENDA FRENCH
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:FRENCH
Last Name:TRAYLOR
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 1:112 N. WEST STREET
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28526-0177
Mailing Address - Country:US
Mailing Address - Phone:252-527-0160
Mailing Address - Fax:
Practice Address - Street 1:400 OLD SMITHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8464
Practice Address - Country:US
Practice Address - Phone:919-581-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC461225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist