MEDICARE: OCCUPATIONAL THERAPY PLUS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	063	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0211W	OTHER	NC	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1194769877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL THERAPY PLUS, INC.

Provider Business Mailing Address
First Line	:	405 W 15TH ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3524
Country	:	US
Telephone Number	:	252-975-1992
Fax Number	:	252-975-3878

Provider Business Practice Location Address
First Line	:	405 W 15TH ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3524
Country	:	US
Telephone Number	:	252-975-1992
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	MR. JAMES GAYNOR
Credential	:	OT
Telephone Number	:	252-975-1992

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	03/31/2010

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