Provider Demographics
NPI:1316662893
Name:INCLUSIVE PEDIATRIC THERAPY
Entity type:Organization
Organization Name:INCLUSIVE PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-438-2051
Mailing Address - Street 1:10205 SAN REMO PL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1624
Mailing Address - Country:US
Mailing Address - Phone:919-438-2051
Mailing Address - Fax:
Practice Address - Street 1:10205 SAN REMO PL
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-1624
Practice Address - Country:US
Practice Address - Phone:919-438-2051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497481147OtherERIN HARDEE
1518366780OtherSTACEY CHAMBERS
1588922694OtherALISON SCULLEY
1770605123OtherSUZANNE ZIEMER