Provider Demographics
NPI:1154581940
Name:PAMLICO PEDIATRIC THERAPY
Entity type:Organization
Organization Name:PAMLICO PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:OESTREICH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:252-975-1234
Mailing Address - Street 1:111 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3840
Mailing Address - Country:US
Mailing Address - Phone:252-975-1234
Mailing Address - Fax:252-975-1000
Practice Address - Street 1:111 AVON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3840
Practice Address - Country:US
Practice Address - Phone:252-975-1234
Practice Address - Fax:252-975-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty