Provider Demographics
NPI:1538511050
Name:ADAPTIVE THERAPY INC
Entity Type:Organization
Organization Name:ADAPTIVE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERRI-KELLY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCLAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-734-4194
Mailing Address - Street 1:4904 FAYETTEVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2146
Mailing Address - Country:US
Mailing Address - Phone:910-734-4194
Mailing Address - Fax:
Practice Address - Street 1:4904 FAYETTEVILLE RD SUITE A
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-4904
Practice Address - Country:US
Practice Address - Phone:910-734-4194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9084225100000X
NC6037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty