Provider Demographics
NPI:1215709852
Name:WASHINGTON OCCUPATIONAL THERAPY LLC
Entity type:Organization
Organization Name:WASHINGTON OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:VANSTAALDUINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-402-9546
Mailing Address - Street 1:755 BREEZY SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NC
Mailing Address - Zip Code:27808-9598
Mailing Address - Country:US
Mailing Address - Phone:252-402-9546
Mailing Address - Fax:
Practice Address - Street 1:611 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3408
Practice Address - Country:US
Practice Address - Phone:252-944-3410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871075424OtherNPI