Healthcare Provider Details

I. General information

NPI: 1356510945
Provider Name (Legal Business Name): ABILITATIONS CHILDREN'S THERAPY & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 RAVEN RIDGE RD SUITE 101
RALEIGH NC
27614
US

IV. Provider business mailing address

11030 RAVEN RIDGE RD SUITE 101
RALEIGH NC
27614-8511
US

V. Phone/Fax

Practice location:
  • Phone: 919-345-6973
  • Fax:
Mailing address:
  • Phone: 919-844-6611
  • Fax: 919-844-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
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: JENNIFER MOCK
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-844-6611