MEDICARE: FOUNDATIONS PEDIATRIC THERAPY 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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1811820525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS PEDIATRIC THERAPY PLLC

Provider Business Mailing Address
First Line	:	7605 STARLING CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-5469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7605 STARLING CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-5469
Country	:	US
Telephone Number	:	262-370-2613
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	CARLIE MCLEOD
Credential	:
Telephone Number	:	262-370-2613

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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