MEDICARE: ISLAND HAND & UPPER BODY REHABILITATION

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	2161	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	182600	OTHER	NC	MEDCOST ID
2	044180	OTHER	NC	AETNA ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P00316027	OTHER	NC	RAILROAD MCR ID
5	11387	OTHER	NC	BCBS ID

General Provider Information

NPI Number	:	1891879912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND HAND & UPPER BODY REHABILITATION

Provider Business Mailing Address
First Line	:	PO BOX 7393
Second Line	:
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-7393
Country	:	US
Telephone Number	:	252-255-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 N. CROATAN HWY
Second Line	:	STE 3, 2ND FLOOR
City	:	KILL DEVIL HILLS
State	:	NC
Zip	:	27948-8516
Country	:	US
Telephone Number	:	252-255-5252
Fax Number	:	252-480-0943

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL D CALHOUN
Credential	:	OTRL
Telephone Number	:	252-255-5252

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/13/2019

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Directions to “ISLAND HAND & UPPER BODY REHABILITATION ” Practice Location

Language	Start Address	Practice Location

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