Healthcare Provider Details

I. General information

NPI: 1114083284
Provider Name (Legal Business Name): COMMUNITY ACCESS THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 03/14/2021
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DUNDAS CIR SUITES BCD
GREENSBORO NC
27407-1662
US

IV. Provider business mailing address

7402 CORNUS CT
SUMMERFIELD NC
27358-9514
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-3338
  • Fax: 336-294-6696
Mailing address:
  • Phone: 336-294-3338
  • Fax: 336-294-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2044
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LESLIE CHESSON WOLFF
Title or Position: PRESIDENT
Credential:
Phone: 336-294-3338