MEDICARE: OT4 KIDS, 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	225100000X	Physical Therapist	1164	NC
2	235Z00000X	Speech-Language Pathologist	8820	NC
3	225X00000X	Occupational Therapist	0149	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	68681	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1831162643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OT4 KIDS, INC

Provider Business Mailing Address
First Line	:	PO BOX 587
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27293-0587
Country	:	US
Telephone Number	:	336-236-6546
Fax Number	:	336-236-9546

Provider Business Practice Location Address
First Line	:	440 CENTRAL AVENUE
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-2634
Country	:	US
Telephone Number	:	336-236-6546
Fax Number	:	336-236-9546

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CAROL FRYE STEPHENS
Credential	:	OTR/L
Telephone Number	:	336-236-6546

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	03/05/2012

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Directions to “OT4 KIDS, INC ” Practice Location

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