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General NPI Number Information
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NPI Number | 1285970434
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Entity Type | Organization
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Legal Business Name | ENVISION REHABILITATION ASSOCIATES LLC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 1713 BEVERLY RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-6308
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Country | US
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Telephone | 252-544-5031
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Fax | 252-544-5031
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Provider Business Mailing Address
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Address Line | PO BOX 2037
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City | ROCKY MOUNT
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State | NC
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Zip | 27802-2037
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Country | US
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Telephone | 252-544-5031
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Fax | 252-544-5031
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NATHLYN OHREE
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Credential | MA/CCC/SLP
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Telephone | 252-544-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1078
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License Number State | NC
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