Provider Demographics
NPI:1225410814
Name:ENVISION REHABILITATION ASSOCTIATES, LLC
Entity Type:Organization
Organization Name:ENVISION REHABILITATION ASSOCTIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHLYN
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:OHREE
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC/SLP
Authorized Official - Phone:252-544-5031
Mailing Address - Street 1:PO BOX 2037
Mailing Address - Street 2:1713 BEVERLY ROAD
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:252-544-5031
Practice Address - Street 1:1713 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-6308
Practice Address - Country:US
Practice Address - Phone:252-544-5031
Practice Address - Fax:252-544-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty