Healthcare Provider Details

I. General information

NPI: 1952869059
Provider Name (Legal Business Name): STEVEN TYLER SORENSEN MOT/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6622 GORDON RD STE L
WILMINGTON NC
28411-8415
US

IV. Provider business mailing address

6622 GORDON RD STE L
WILMINGTON NC
28411-8415
US

V. Phone/Fax

Practice location:
  • Phone: 910-407-7211
  • Fax:
Mailing address:
  • Phone: 910-407-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number13386
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: