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General NPI Number Information
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NPI Number | 1659712412
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Entity Type | Organization
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Legal Business Name | LOCUS FAMILY CENTERED THERAPIES
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 5209 NEUSE TAVERN CT
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City | RALEIGH
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State | NC
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Zip | 27616-7889
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Country | US
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Telephone | 919-578-3285
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Fax |
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Provider Business Mailing Address
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Address Line | 5209 NEUSE TAVERN CT
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City | RALEIGH
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State | NC
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Zip | 27616-7889
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Country | US
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Telephone | 919-578-3285
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | LESLIE BETH HATHAWAY
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Credential | OTR/L
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Telephone | 919-578-3285
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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 | 4887
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License Number State | NC
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