Healthcare Provider Details

I. General information

NPI: 1225586324
Provider Name (Legal Business Name): YAY OT 4 KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2016
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N 15TH ST
WILMINGTON NC
28401-3813
US

IV. Provider business mailing address

305 N 15TH ST
WILMINGTON NC
28401-3813
US

V. Phone/Fax

Practice location:
  • Phone: 910-685-7007
  • Fax: 910-516-1666
Mailing address:
  • Phone: 910-685-7007
  • Fax: 910-516-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3841
License Number StateNC

VIII. Authorized Official

Name: MRS. KIMBERLY MCCALL
Title or Position: OWNER/THERAPIST
Credential: OTR/L
Phone: 828-582-7109