Provider Demographics
NPI:1255456513
Name:PEDIATRIC HANDS ON THERAPY, PC
Entity type:Organization
Organization Name:PEDIATRIC HANDS ON THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREIDA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:POAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-320-8275
Mailing Address - Street 1:PO BOX 1471
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-1471
Mailing Address - Country:US
Mailing Address - Phone:704-747-3788
Mailing Address - Fax:
Practice Address - Street 1:2557 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4712
Practice Address - Country:US
Practice Address - Phone:980-320-8275
Practice Address - Fax:704-973-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 235Z00000X
NC3364225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212116Medicaid