Healthcare Provider Details

I. General information

NPI: 1164249678
Provider Name (Legal Business Name): DOGWOOD REHAB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 BONNIE STREET
WILLOW SPRING NC
27592
US

IV. Provider business mailing address

2233 BONNIE ST
WILLOW SPRING NC
27592-4603
US

V. Phone/Fax

Practice location:
  • Phone: 919-614-5054
  • Fax:
Mailing address:
  • Phone: 919-614-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH K BROUGHTON
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: MOT, OTR/L
Phone: 919-614-5054