Provider Demographics
NPI:1124341276
Name:INTEGRATION STATION
Entity type:Organization
Organization Name:INTEGRATION STATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CYPHERT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:704-248-1146
Mailing Address - Street 1:8511 DAVIS LAKE PKWY
Mailing Address - Street 2:SUITE #C6-218
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0536
Mailing Address - Country:US
Mailing Address - Phone:704-248-1146
Mailing Address - Fax:877-268-5344
Practice Address - Street 1:8511 DAVIS LAKE PKWY
Practice Address - Street 2:SUITE #C6-218
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0536
Practice Address - Country:US
Practice Address - Phone:704-248-1146
Practice Address - Fax:877-268-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5804225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty