Provider Demographics
NPI:1891879912
Name:ISLAND HAND & UPPER BODY REHABILITATION
Entity Type:Organization
Organization Name:ISLAND HAND & UPPER BODY REHABILITATION
Other - Org Name:ISLAND OCCUPATIONAL THERAPY AND REHABILITATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:252-255-5252
Mailing Address - Street 1:PO BOX 7393
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-7393
Mailing Address - Country:US
Mailing Address - Phone:252-255-5252
Mailing Address - Fax:
Practice Address - Street 1:3210 N. CROATAN HWY
Practice Address - Street 2:STE 3, 2ND FLOOR
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-8516
Practice Address - Country:US
Practice Address - Phone:252-255-5252
Practice Address - Fax:252-480-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC182600OtherMEDCOST ID
NC044180OtherAETNA ID
NC7301179Medicaid
NCP00316027OtherRAILROAD MCR ID
NC11387OtherBCBS ID
NC182600OtherMEDCOST ID
NCP00316027OtherRAILROAD MCR ID