Provider Demographics
NPI:1700038585
Name:INDEPENDENT OCCUPATIONAL THERAPY, INC.
Entity Type:Organization
Organization Name:INDEPENDENT OCCUPATIONAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BERKEBILE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:910-520-2702
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-1437
Mailing Address - Country:US
Mailing Address - Phone:910-520-2702
Mailing Address - Fax:910-509-9397
Practice Address - Street 1:732B S LUMINA AVE
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480-2168
Practice Address - Country:US
Practice Address - Phone:910-520-2702
Practice Address - Fax:910-509-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-11
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5204251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211458Medicaid
NC7200226Medicaid