Provider Demographics
NPI:1225102031
Name:CAROLINA OCCUPATIONAL THERAPY OF GREENVILLE, INC
Entity Type:Organization
Organization Name:CAROLINA OCCUPATIONAL THERAPY OF GREENVILLE, INC
Other - Org Name:CAROLINA OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-757-1691
Mailing Address - Street 1:1038 W H SMITH BLVD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5051
Mailing Address - Country:US
Mailing Address - Phone:252-757-1691
Mailing Address - Fax:888-430-0123
Practice Address - Street 1:1038 WH SMITH BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5051
Practice Address - Country:US
Practice Address - Phone:252-757-1691
Practice Address - Fax:888-430-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAA381277225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301085Medicaid
NC0175970001Medicare NSC
NC7301085Medicaid