Provider Demographics
NPI:1700161106
Name:UNIQUELY ME CHILDREN'S THERAPY, P.C.
Entity Type:Organization
Organization Name:UNIQUELY ME CHILDREN'S THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:EASON
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OT/L
Authorized Official - Phone:828-674-1688
Mailing Address - Street 1:19 WHIPPORWILL DR
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9519
Mailing Address - Country:US
Mailing Address - Phone:674-674-1688
Mailing Address - Fax:
Practice Address - Street 1:19 WHIPPORWILL DR
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9519
Practice Address - Country:US
Practice Address - Phone:828-674-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4870225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301703Medicaid
NC1669474342OtherINDIVIDUAL NPI