Healthcare Provider Details

I. General information

NPI: 1700038585
Provider Name (Legal Business Name): INDEPENDENT OCCUPATIONAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2008
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732B S LUMINA AVE
WRIGHTSVILLE BEACH NC
28480-2168
US

IV. Provider business mailing address

PO BOX 1437
WRIGHTSVILLE BEACH NC
28480-1437
US

V. Phone/Fax

Practice location:
  • Phone: 910-520-2702
  • Fax: 910-509-9397
Mailing address:
  • Phone: 910-520-2702
  • Fax: 910-509-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5204
License Number StateNC

VIII. Authorized Official

Name: SETH JAMES BERKEBILE
Title or Position: OWNER
Credential: MS, OTR/L
Phone: 910-520-2702