Healthcare Provider Details

I. General information

NPI: 1740378587
Provider Name (Legal Business Name): CHRISTINA NEEDHAM O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SHUCKIN ST
HAMPSTEAD NC
28443-8729
US

IV. Provider business mailing address

1000 EDDY ST
PROVIDENCE RI
02905-4739
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-4444
  • Fax:
Mailing address:
  • Phone: 401-533-9280
  • Fax: 401-533-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number15109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: