Provider Demographics
NPI:1407056724
Name:ADAMS, BRIAN MATTHEW (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1024
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1024
Mailing Address - Country:US
Mailing Address - Phone:336-844-4249
Mailing Address - Fax:336-844-4819
Practice Address - Street 1:697 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-9562
Practice Address - Country:US
Practice Address - Phone:336-844-4249
Practice Address - Fax:336-844-4819
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6541225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1469FOtherBCBS
NC7302011Medicaid