Healthcare Provider Details

I. General information

NPI: 1750893178
Provider Name (Legal Business Name): JOANN JODI PETRY MS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 HILLANDALE RD STE 1B-246
DURHAM NC
27705-2659
US

IV. Provider business mailing address

1821 HILLANDALE RD STE 1B-246
DURHAM NC
27705-2659
US

V. Phone/Fax

Practice location:
  • Phone: 919-213-0296
  • Fax: 919-382-3028
Mailing address:
  • Phone: 919-213-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3779
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number3779
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: