Healthcare Provider Details

I. General information

NPI: 1699967547
Provider Name (Legal Business Name): COMPLETE REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 MEADOW BROOK MALL SUITE 22
CLEMMONS NC
27012-8775
US

IV. Provider business mailing address

6000 MEADOW BROOK MALL SUITE 22
CLEMMONS NC
27012-8775
US

V. Phone/Fax

Practice location:
  • Phone: 336-778-0292
  • Fax: 336-778-0242
Mailing address:
  • Phone: 336-778-0292
  • Fax: 336-778-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEAN P DAVENPORT
Title or Position: OFFICE MGR
Credential:
Phone: 336-778-0292