Provider Demographics
NPI:1720104086
Name:SOLOMON, THERESA P
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:P
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HENRY WARREN RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27314-9569
Mailing Address - Country:US
Mailing Address - Phone:336-562-3273
Mailing Address - Fax:336-503-5625
Practice Address - Street 1:300 MEADOWLAND DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8502
Practice Address - Country:US
Practice Address - Phone:919-732-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2536225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist