Provider Demographics
NPI:1639394828
Name:LITTLE ACHIEVERS THERAPY
Entity Type:Organization
Organization Name:LITTLE ACHIEVERS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LOCKE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:919-772-0956
Mailing Address - Street 1:12450 CLEVELAND RD
Mailing Address - Street 2:STE 104
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8353
Mailing Address - Country:US
Mailing Address - Phone:919-772-0956
Mailing Address - Fax:
Practice Address - Street 1:12450 CLEVELAND RD
Practice Address - Street 2:STE 104
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8353
Practice Address - Country:US
Practice Address - Phone:919-772-0956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP101822251P0200X
NC5768225XP0200X
NC8458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200136Medicaid