Healthcare Provider Details

I. General information

NPI: 1235506965
Provider Name (Legal Business Name): THERACCESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PEMBERTON HILL RD SUITE 102
APEX NC
27502-3957
US

IV. Provider business mailing address

1101 PEMBERTON HILL RD SUITE 102
APEX NC
27502-3957
US

V. Phone/Fax

Practice location:
  • Phone: 919-421-4263
  • Fax: 919-800-3236
Mailing address:
  • Phone: 919-421-4263
  • Fax: 919-800-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9903
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CHETAN DESHMUKH
Title or Position: CEO
Credential: MBA, OTR/L, CPC, CHD
Phone: 919-421-4263