Provider Demographics
NPI:1033995253
Name:PITTS, JELANI NADIRI (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:JELANI
Middle Name:NADIRI
Last Name:PITTS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 WATERFORD VALLEY DR APT 1318
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8319
Mailing Address - Country:US
Mailing Address - Phone:727-871-1641
Mailing Address - Fax:
Practice Address - Street 1:300 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4493
Practice Address - Country:US
Practice Address - Phone:984-528-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1598154098Medicaid