Provider Demographics
NPI:1932359601
Name:REHAB REMEDIES OF EASTERN NORTH CAROLINA
Entity Type:Organization
Organization Name:REHAB REMEDIES OF EASTERN NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DWAN
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, CCC-SLP
Authorized Official - Phone:252-230-6947
Mailing Address - Street 1:PO BOX 4182
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-0182
Mailing Address - Country:US
Mailing Address - Phone:252-230-6947
Mailing Address - Fax:252-442-7341
Practice Address - Street 1:1009 NASH ST E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-6339
Practice Address - Country:US
Practice Address - Phone:252-230-6947
Practice Address - Fax:252-442-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty