Provider Demographics
NPI:1497282479
Name:ADVANTAGE OT, PC
Entity Type:Organization
Organization Name:ADVANTAGE OT, PC
Other - Org Name:ADVANTAGE DURABLE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:910-298-2331
Mailing Address - Street 1:160 N NC 241 HWY
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-8636
Mailing Address - Country:US
Mailing Address - Phone:910-298-2331
Mailing Address - Fax:910-375-3031
Practice Address - Street 1:160 N NC 241 HWY
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8636
Practice Address - Country:US
Practice Address - Phone:910-298-2331
Practice Address - Fax:910-375-3031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANTAGE OT, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200372Medicaid