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General NPI Number Information
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NPI Number | 1326518234
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Entity Type | Organization
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Legal Business Name | DYNAMIC OCCUPATIONAL THERAPY, LLC
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 99 DRIFTWOOD DR
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City | GERRARDSTOWN
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State | WV
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Zip | 25420-4317
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Country | US
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Telephone | 304-579-7155
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Fax | 304-229-7205
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Provider Business Mailing Address
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Address Line | 99 DRIFTWOOD DR
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City | GERRARDSTOWN
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State | WV
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Zip | 25420-4317
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Country | US
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Telephone | 304-579-7155
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Fax | 304-229-7205
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Authorized Official
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Title or Position | OWNER
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Name | LISA GREGORY
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Credential |
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Telephone | 304-579-7155
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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 |
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License Number State |
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