Healthcare Provider Details

I. General information

NPI: 1215111695
Provider Name (Legal Business Name): HAND WITH HEART THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EAGLES REACH DRIVE DAVID SINK BLD-BRCC
FLAT ROCK NC
28731-4728
US

IV. Provider business mailing address

204 MERRIWOOD LN
HENDERSONVILLE NC
28791-3853
US

V. Phone/Fax

Practice location:
  • Phone: 828-606-0295
  • Fax: 828-890-8941
Mailing address:
  • Phone: 828-890-8941
  • Fax: 828-890-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1376
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier7212289
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: KATHY W HAYNES
Title or Position: MANAGER
Credential:
Phone: 828-606-0295