Healthcare Provider Details

I. General information

NPI: 1154687655
Provider Name (Legal Business Name): WEEHABILITATE-PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E MILLBROOK RD SUITE 117
RALEIGH NC
27604-1788
US

IV. Provider business mailing address

2200 E MILLBROOK RD SUITE 117
RALEIGH NC
27604-1788
US

V. Phone/Fax

Practice location:
  • Phone: 919-880-5770
  • Fax: 919-882-8605
Mailing address:
  • Phone: 919-880-5770
  • Fax: 919-882-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE LEIGHAN PARTEN
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT, OTR/L
Phone: 919-880-5770