Healthcare Provider Details

I. General information

NPI: 1518165646
Provider Name (Legal Business Name): VISION OF THERAPEUTIC DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S MAIN ST SUITE H
GRAHAM NC
27253-2808
US

IV. Provider business mailing address

PO BOX 1223
MEBANE NC
27302-1223
US

V. Phone/Fax

Practice location:
  • Phone: 336-227-7878
  • Fax: 336-227-7810
Mailing address:
  • Phone: 336-227-7878
  • Fax: 336-227-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: NORMA BURTON
Title or Position: OWNER/PRESIDENT
Credential: QMHP
Phone: 336-227-7878