Healthcare Provider Details

I. General information

NPI: 1225360746
Provider Name (Legal Business Name): IMAGINATION THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5856 FARINGDON PL STE 1
RALEIGH NC
27609-4586
US

IV. Provider business mailing address

5856 FARINGDON PL STE 1
RALEIGH NC
27609-4586
US

V. Phone/Fax

Practice location:
  • Phone: 919-324-1881
  • Fax: 919-324-1781
Mailing address:
  • Phone: 919-324-1881
  • Fax: 919-324-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SUNITA MURTY-GAMI
Title or Position: MANAGER OCCUPATIONAL THERAPIST
Credential: MS OTRL ITFS
Phone: 919-324-1881