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General NPI Number Information
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NPI Number | 1043792500
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Entity Type | Organization
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Legal Business Name | THE ACCOMMODATION STATION, LLC
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 515 COLLEGE RD STE 14
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City | GREENSBORO
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State | NC
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Zip | 27410-5150
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Country | US
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Telephone | 917-502-8871
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Fax |
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Provider Business Mailing Address
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Address Line | 5939 W FRIENDLY AVE APT 26L
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City | GREENSBORO
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State | NC
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Zip | 27410-3351
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Country | US
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Telephone | 917-502-8871
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDRA DANTEC
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Credential | OTR/L
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Telephone | 917-502-8871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 11187
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License Number State | NC
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