Healthcare Provider Details

I. General information

NPI: 1992020960
Provider Name (Legal Business Name): ALI M ADLAH OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 ELLABOND ST
SNEADS FERRY NC
28460-1412
US

IV. Provider business mailing address

704 ELLABOND ST
SNEADS FERRY NC
28460-1412
US

V. Phone/Fax

Practice location:
  • Phone: 631-774-3055
  • Fax:
Mailing address:
  • Phone: 631-774-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13467
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: