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General NPI Number Information
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NPI Number | 1760507990
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Entity Type | Organization
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Legal Business Name | EAST CAROLINA UNIVERSITY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | IRONS BUILDING-OGLESBY DR.
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City | GREENVILLE
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State | NC
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Zip | 27858
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Country | US
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Telephone | 252-737-1177
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Fax | 252-328-4486
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Provider Business Mailing Address
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Address Line | IRONS BUILDING-OGLESBY DR.
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City | GREENVILLE
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State | NC
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Zip | 27858
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Country | US
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Telephone | 252-737-1177
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Fax | 252-328-4486
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Authorized Official
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Title or Position | DIRECTOR COSA
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Name | MR. GARY JUDSON STAINBACK
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Credential | PHD
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Telephone | 252-737-1167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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Taxonomy #6
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225CA2400X
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Taxonomy Name | Assistive Technology Practitioner Rehabilitation Counselor
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License Number |
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Taxonomy #9
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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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Taxonomy #10
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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Taxonomy #11
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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