Provider Demographics
NPI:1205551579
Name:THIGPEN, GEORGIA BROOKE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:BROOKE
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 E WARDS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-8777
Mailing Address - Country:US
Mailing Address - Phone:910-375-2580
Mailing Address - Fax:
Practice Address - Street 1:160 N NC 241 HWY
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8636
Practice Address - Country:US
Practice Address - Phone:910-298-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15482225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist