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General NPI Number Information
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NPI Number | 1356041214
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Entity Type | Organization
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Legal Business Name | CHAPEL HILL SKATE PROGRAM, PLLC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 109 PLANT RD
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City | CHAPEL HILL
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State | NC
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Zip | 27514-3337
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Country | US
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Telephone | 919-932-7399
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17301
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City | CHAPEL HILL
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State | NC
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Zip | 27516-7200
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Country | US
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Telephone | 919-932-7399
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | RYAN OGILVY
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Credential | OTA
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Telephone | 919-932-7399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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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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