MS. SHAVERENCE LAWANDA OUTLAW (NPI# 1194356170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194356170 |
| Entity Type | Individual |
| Full Name | MS. SHAVERENCE LAWANDA OUTLAW |
| Credential | LRT |
| Practice Address |
3890 Old Vineyard Rd Apt 86b Winston Salem NC 27104-4880 |
| Practice Telephone | 3366044537 |
| Mailing Telephone | 3366044537 |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2020-01-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225800000X | Recreation Therapist | 3879 | NC | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CTRS | 80617 | 01 | |
| NC | NCBRTL | 3879 | 01 |
| Street Address |
3890 OLD VINEYARD RD APT 86B |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27104-4880 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447807664 | Cameron Grant Ford | Psychologist | 614 Country Club Road, Winston-salem, NC 27104 | 2019-08-22 |
| 1104310374 | Novant Medical Group, Inc. | Internal Medicine | 4937 Old Country Club Rd, Winston Salem, NC 27104 | 2018-06-20 |
| 1982100509 | Dillon James Magalski | Student in an Organized Health Care Education/Training Program | Piedmont Plaza 1, 1920 West First Street, Wake Forest Baptist Medical Center, Winston-salem, NC 27104 | 2018-04-03 |
| 1891290144 | Breann M Poling | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Center, Department Of, Family Medicine Piedmont Plaza I 1920 West First Street, Winston Salem, NC 27104 | 2018-03-28 |
| 1689178600 | Christopher Vasil | Student in an Organized Health Care Education/Training Program | Piedmont Plaza I, 1920 West First Street, Department of Family Medicine, Winston Salem, NC 27104 | 2018-03-23 |
| 1407379126 | April Lynn Lowe | Registered Nurse | 940 N Peace Haven Rd, Winstonsalem, NC 27104 | 2017-07-25 |
| 1164950804 | Donald Joyce | Student in an Organized Health Care Education/Training Program | 1920 West First St, Piedmont Plaza I Building, 3rd Floor, Winston-salem, NC 27104 | 2017-05-25 |
| 1255867289 | Benjamin Hansen | Pharmacist | 2150 Country Club Rd Ste 300, Winston Salem, NC 27104 | 2017-05-11 |
| 1770020976 | Jane Reed | Physical Medicine & Rehabilitation | 2627 E Greenbrier Road, Winston Salem, NC 27104 | 2017-01-25 |
| 1053728261 | Ashraf Alsaedi | Pharmacist | 1659 Stratford Rd Nw, Winston Salem, NC 27104 | 2014-07-20 |
| Find all providers in zip 27104 | ||||
| Taxonomy Code | 225800000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Recreation Therapist |
| A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. |
| Notes: Source: Joel A. DeLisa and Bruce M. Gans, Rehabilitation Medicine: Principles and Practice Second Edition, J.B. Lippincott Company, Philadelphia: 1993, p. 7 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043876493 | Home Again Senior Living Communities, LLC | Recreation Therapist | 1348 Westgate Center Dr, Winston Salem, NC 27103-2984 | 2019-05-10 |
| 1730201955 | Tracie Diane Hobbs | Recreation Therapist | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2007-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578037073 | Family First Physical Therapy L.L.C. | Recreation Therapist | 2726 Barringer Dr, Charlotte, NC 28208-7008 | 2019-01-17 |
| 1629593454 | Wesley Tyler | Recreation Therapist | 9139b Trinity Rd, Charlotte, NC 28216-1900 | 2017-08-14 |
| 1962923474 | Vernice Dolores Gallon Clyburn | Recreation Therapist | 126 S Rose Ave, Kannapolis, NC 28083-3552 | 2017-07-06 |
| 1316334618 | Shannon O'rawe | Recreation Therapist | 1707 Waterclose Ct, Apex, NC 27502-6264 | 2015-04-24 |
| 1073928685 | Allison Westpfahl | Recreation Therapist | 1208 Ben Williams Rd, Richlands, NC 28574-5128 | 2014-06-23 |
| 1467722736 | Melissa Sue Walker | Recreation Therapist | 6213 Lowergate Dr, Waxhaw, NC 28173-6747 | 2012-01-04 |
| 1881971174 | Melissa Hunt Lewis | Recreation Therapist | 4907 Creekside Dr, New Bern, NC 28562-5007 | 2011-11-15 |
| 1992002893 | Lois Stanga Harvin | Recreation Therapist | 1607 Temple St Sw, Valdese, NC 28690-9330 | 2011-02-12 |
| 1518261205 | James D Dozier-dozia | Recreation Therapist | 1245-b Independence Dr, Rocky Mt, NC 27804 | 2011-01-10 |
| 1093032096 | Myra S Austin | Recreation Therapist | 2551 Homestead Rd, Chapel Hill, NC 27516-9087 | 2010-04-29 |
| Find all providers with the same taxonomy | ||||
| City | WINSTON SALEM |
| Zip Code | 27104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.