Provider Demographics
NPI:1497917389
Name:GREENLIGHT OCCUPATIONAL THERAPY, PC
Entity Type:Organization
Organization Name:GREENLIGHT OCCUPATIONAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-619-7690
Mailing Address - Street 1:413 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2304
Mailing Address - Country:US
Mailing Address - Phone:910-619-7690
Mailing Address - Fax:910-790-9832
Practice Address - Street 1:413 BRADFORD RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2304
Practice Address - Country:US
Practice Address - Phone:910-619-7690
Practice Address - Fax:910-790-9832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5427251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health