=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235616392
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIMBTECH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2018
-----------------------------------------------------
Last Update Date | 07/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 186 BUTLER RIDGE TRL
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28792-8055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-351-3261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 186 BUTLER RIDGE TRL
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28792-8055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-351-3261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | DR. AMY M SIEGLER
-----------------------------------------------------
Credential | OTD, OTR/L, BOCO
-----------------------------------------------------
Telephone | 907-351-3261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 9201
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------