Healthcare Provider Details

I. General information

NPI: 1568716868
Provider Name (Legal Business Name): LIFETOUCHTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9597 INDIAN BEECH AVE NW
CONCORD NC
28027-3573
US

IV. Provider business mailing address

9597 INDIAN BEECH AVE NW
CONCORD NC
28027-3573
US

V. Phone/Fax

Practice location:
  • Phone: 973-896-4332
  • Fax: 704-793-6308
Mailing address:
  • Phone: 973-896-4332
  • Fax: 704-793-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number8405
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6958
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7879
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7113
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7786
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10501
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: CAROLYNN SOLANO
Title or Position: OWNER
Credential:
Phone: 973-896-4332