Provider Demographics
NPI:1538839915
Name:REDUCED BARRIERS
Entity type:Organization
Organization Name:REDUCED BARRIERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECREATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAVERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLAW
Authorized Official - Suffix:
Authorized Official - Credentials:LRT/CTRS
Authorized Official - Phone:336-604-4537
Mailing Address - Street 1:615 SAINT GEORGE SQUARE CT STE 300
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1368
Mailing Address - Country:US
Mailing Address - Phone:336-604-4537
Mailing Address - Fax:
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT STE 300
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:336-604-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3879OtherLRT