Provider Demographics
NPI:1225146095
Name:DEVELOPMENTAL THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DEVELOPMENTAL THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:STIVLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA, OTR/L
Authorized Official - Phone:919-493-7002
Mailing Address - Street 1:3514 UNIVERSITY DR
Mailing Address - Street 2:OFFICE #8
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6247
Mailing Address - Country:US
Mailing Address - Phone:919-493-7002
Mailing Address - Fax:919-403-1407
Practice Address - Street 1:3514 UNIVERSITY DR
Practice Address - Street 2:OFFICE #8
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6247
Practice Address - Country:US
Practice Address - Phone:919-493-7002
Practice Address - Fax:919-403-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0199HOtherBCBS NC GROUP NUMBER
NC720199HMedicaid