Healthcare Provider Details

I. General information

NPI: 1649871807
Provider Name (Legal Business Name): LITTLE BEAM REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 US HIGHWAY 64 W
PLYMOUTH NC
27962-9325
US

IV. Provider business mailing address

1213 CHESHIRE LN
ROCKY MOUNT NC
27803-1246
US

V. Phone/Fax

Practice location:
  • Phone: 919-717-0245
  • Fax:
Mailing address:
  • Phone: 252-231-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE NICOLE BIGGS AYERS
Title or Position: OCCUPATIONAL THERAPIST/ OWNER
Credential: OTR/L
Phone: 919-717-0245