Provider Demographics
NPI:1366129678
Name:MAYBERRY, ZOE SOPHIA (OTR)
Entity type:Individual
Prefix:MRS
First Name:ZOE
Middle Name:SOPHIA
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ZOE
Other - Middle Name:SOPHIA
Other - Last Name:SHIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:207 ABERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-0198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16409 NORTHCROSS DR STE 2106
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5065
Practice Address - Country:US
Practice Address - Phone:980-441-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist