Provider Demographics
NPI:1225360746
Name:IMAGINATION THERAPY PLLC
Entity Type:Organization
Organization Name:IMAGINATION THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURTY-GAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTRL ITFS
Authorized Official - Phone:919-324-1881
Mailing Address - Street 1:5856 FARINGDON PL STE 1
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4586
Mailing Address - Country:US
Mailing Address - Phone:919-324-1881
Mailing Address - Fax:919-324-1781
Practice Address - Street 1:5856 FARINGDON PL STE 1
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4586
Practice Address - Country:US
Practice Address - Phone:919-324-1881
Practice Address - Fax:919-324-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303115KMedicaid