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General NPI Number Information
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NPI Number | 1902520828
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Entity Type | Organization
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Legal Business Name | OUR VILLAGE THERAPY, PLLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 7316 RIDGE GROVE CT
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City | RALEIGH
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State | NC
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Zip | 27615-5908
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Country | US
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Telephone | 919-417-7259
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Fax |
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Provider Business Mailing Address
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Address Line | 7316 RIDGE GROVE CT
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City | RALEIGH
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State | NC
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Zip | 27615-5908
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Country | US
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Telephone | 919-417-7259
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNIFER L WALTHER
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Credential | MS, OTR/L
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Telephone | 919-417-7259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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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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