Healthcare Provider Details

I. General information

NPI: 1134713019
Provider Name (Legal Business Name): LIVELY THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S RIDGE AVE
KANNAPOLIS NC
28083-6056
US

IV. Provider business mailing address

PO BOX 248
KANNAPOLIS NC
28082-0248
US

V. Phone/Fax

Practice location:
  • Phone: 980-242-0690
  • Fax:
Mailing address:
  • Phone: 980-242-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MEGAN PRISCILLA BUCKLAND
Title or Position: OWNER
Credential: OTR/L
Phone: 704-960-9619