Provider Demographics
NPI:1487074399
Name:PREVETTE, TRAVIS WATSON (OTR/L)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:WATSON
Last Name:PREVETTE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BOSTIC
Mailing Address - State:NC
Mailing Address - Zip Code:28018-8759
Mailing Address - Country:US
Mailing Address - Phone:828-245-9095
Mailing Address - Fax:
Practice Address - Street 1:149 FAIRHAVEN DR
Practice Address - Street 2:
Practice Address - City:BOSTIC
Practice Address - State:NC
Practice Address - Zip Code:28018-8759
Practice Address - Country:US
Practice Address - Phone:828-245-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist