Provider Demographics
NPI:1346523511
Name:CAROLINA MOBILE THERAPY
Entity Type:Organization
Organization Name:CAROLINA MOBILE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT/L
Authorized Official - Prefix:MISS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:919-413-9901
Mailing Address - Street 1:5701 QUAIL COVEY LN
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-9506
Mailing Address - Country:US
Mailing Address - Phone:919-413-9901
Mailing Address - Fax:
Practice Address - Street 1:5701 QUAIL COVEY LN
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-9506
Practice Address - Country:US
Practice Address - Phone:919-413-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty