Provider Demographics
NPI:1326518234
Name:DYNAMIC OCCUPATIONAL THERAPY, LLC
Entity type:Organization
Organization Name:DYNAMIC OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-579-7155
Mailing Address - Street 1:99 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERRARDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25420-4317
Mailing Address - Country:US
Mailing Address - Phone:304-579-7155
Mailing Address - Fax:304-229-7205
Practice Address - Street 1:99 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:GERRARDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25420-4317
Practice Address - Country:US
Practice Address - Phone:304-579-7155
Practice Address - Fax:304-229-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty