Healthcare Provider Details

I. General information

NPI: 1518674506
Provider Name (Legal Business Name): FUNCTIONAL DIFFERENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 INVERNESS ST
ZEBULON NC
27597-3310
US

IV. Provider business mailing address

343 INVERNESS ST
ZEBULON NC
27597-3310
US

V. Phone/Fax

Practice location:
  • Phone: 919-480-7008
  • Fax: 919-882-8502
Mailing address:
  • Phone: 919-480-7008
  • Fax: 919-882-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRITTNEY TARA WALDEN
Title or Position: CEO
Credential: MS, OTR/L
Phone: 919-480-7008