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General NPI Number Information
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NPI Number | 1154581940
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Entity Type | Organization
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Legal Business Name | PAMLICO PEDIATRIC THERAPY
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Dates
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Enumeration Date | 06/15/2008
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Last Update Date | 06/15/2008
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Provider Practice Location Address
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Address Line | 111 AVON AVE
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City | WASHINGTON
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State | NC
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Zip | 27889-3840
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Country | US
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Telephone | 252-975-1234
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Fax | 252-975-1000
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Provider Business Mailing Address
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Address Line | 111 AVON AVE
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City | WASHINGTON
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State | NC
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Zip | 27889-3840
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Country | US
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Telephone | 252-975-1234
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Fax | 252-975-1000
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | MS. CATHERINE AMANDA OESTREICH
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Credential | OTR/L
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Telephone | 252-975-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5144
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License Number State | NC
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