Provider Demographics
NPI:1740505346
Name:INTERACT PEDIATRIC THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:INTERACT PEDIATRIC THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT/L; CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:336-279-9008
Mailing Address - Street 1:5603 W FRIENDLY AVE STE B
Mailing Address - Street 2:#274
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4252
Mailing Address - Country:US
Mailing Address - Phone:336-772-5499
Mailing Address - Fax:336-740-9099
Practice Address - Street 1:3907 W MARKET ST # A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1303
Practice Address - Country:US
Practice Address - Phone:336-772-5499
Practice Address - Fax:336-740-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4531225XP0200X
NC3223235Z00000X
235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200380Medicaid