Healthcare Provider Details

I. General information

NPI: 1164123352
Provider Name (Legal Business Name): NAMIYAH REDDICKS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEDRICK DR
THOMASVILLE NC
27360-6009
US

IV. Provider business mailing address

115 S RAILROAD AVE
DUNN NC
28334-4853
US

V. Phone/Fax

Practice location:
  • Phone: 540-492-2808
  • Fax:
Mailing address:
  • Phone: 984-500-0242
  • Fax: 984-500-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: