=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770768798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUSE RIVER THERAPY P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2008
-----------------------------------------------------
Last Update Date | 01/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8520 SIX FORKS RD SUITE 201
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-3095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-906-1270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2632 DUNLORING DR
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-9021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-562-2935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JAMIE TUOHY
-----------------------------------------------------
Credential | O.T.R./L
-----------------------------------------------------
Telephone | 919-906-1270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 5238
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------