Lisa Flythe Durham, MS, OTR/L

Primary specialty

Gerontology Occupational TherapistTaxonomy code 225XG0600X

License

5879 Issued in NC

Practice address

200 Hampton Woods Complex Rd
Jackson, NC 27845-9503

Phone

(252) 578-3751

NPI assigned

Aug 13, 2012

Last updated

Aug 13, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1619224284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAMPTON WOODS COMPLEX RD",
            "city": "JACKSON",
            "state": "NC",
            "postal_code": "278459503",
            "telephone_number": "252-578-3751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAMPTON WOODS COMPLEX RD",
            "city": "JACKSON",
            "state": "NC",
            "postal_code": "278459503",
            "telephone_number": "252-578-3751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURHAM",
        "first_name": "LISA",
        "middle_name": "FLYTHE",
        "name_prefix": "Mrs.",
        "credential": "MS, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "NC",
            "license": "5879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Occupational Therapist in Jackson, NC
• Providers in Jackson, NC by specialty
• Gerontology Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.