Provider Demographics
NPI:1437952124
Name:GARDNER, MARY CECILIA (OT/L)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CECILIA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT/L
Mailing Address - Street 1:12427 SWAN WINGS PL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-2342
Mailing Address - Country:US
Mailing Address - Phone:704-956-3417
Mailing Address - Fax:704-956-3417
Practice Address - Street 1:12427 SWAN WINGS PL
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2342
Practice Address - Country:US
Practice Address - Phone:704-956-3417
Practice Address - Fax:704-956-3417
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist