Provider Demographics
NPI:1194769877
Name:OCCUPATIONAL THERAPY PLUS, INC.
Entity type:Organization
Organization Name:OCCUPATIONAL THERAPY PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:252-975-1992
Mailing Address - Street 1:405 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3524
Mailing Address - Country:US
Mailing Address - Phone:252-975-1992
Mailing Address - Fax:252-975-3878
Practice Address - Street 1:405 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3524
Practice Address - Country:US
Practice Address - Phone:252-975-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC063225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC720211WMedicaid
NC0211WOtherBCBS GROUP NUMBER