Provider Demographics
NPI:1659688158
Name:GO YOUR OWN WAY, INC.
Entity Type:Organization
Organization Name:GO YOUR OWN WAY, INC.
Other - Org Name:LEARNING CHARMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SEYMORE
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:MOT
Authorized Official - Phone:980-721-4839
Mailing Address - Street 1:1532 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1546
Mailing Address - Country:US
Mailing Address - Phone:980-225-5414
Mailing Address - Fax:980-229-4642
Practice Address - Street 1:1532 STERLING RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1546
Practice Address - Country:US
Practice Address - Phone:980-721-4839
Practice Address - Fax:980-229-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200486Medicaid