Healthcare Provider Details

I. General information

NPI: 1811820525
Provider Name (Legal Business Name): FOUNDATIONS PEDIATRIC THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 STARLING CT
RALEIGH NC
27615-5469
US

IV. Provider business mailing address

7605 STARLING CT
RALEIGH NC
27615-5469
US

V. Phone/Fax

Practice location:
  • Phone: 262-370-2613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARLIE MCLEOD
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 262-370-2613