MEDICARE: OCCUVISION THERAPY SERVICES, PLLC

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	225XL0004X	Low Vision Occupational Therapist	6381	NC

General Provider Information

NPI Number	:	1780087387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUVISION THERAPY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 18751
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28218-0751
Country	:	US
Telephone Number	:	704-315-9182
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 WINTER ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3659
Country	:	US
Telephone Number	:	704-315-9182
Fax Number	:

Authorized Official
Title or Position	:	PART-OWNER
Name	:	CATHERINE HOLSTEN
Credential	:	OTR/L
Telephone Number	:	704-315-9182

Provider Enumeration Date	:	09/27/2014
Last Update Date	:	10/02/2014

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