# PRIME OCCUPATIONAL THERAPY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780036988
- **Authorized official:** MRS. MAHTSENTE WORKU EBRON MSHS OTR/L (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (919) 539-8661

## Contact information

- **Practice address:** 1004 PEONY CT, KNIGHTDALE, NC 27545-7051
- **Practice address phone:** (919) 539-8661
- **Practice address fax:** (919) 373-9564
- **Mailing address:** 1004 PEONY CT, KNIGHTDALE, NC 27545-7051
- **Mailing address phone:** (919) 539-8661
- **Mailing address fax:** (919) 373-9564

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 4262 | NC | Yes |

## Other

- **Enumeration date:** 07/12/2016
- **Last updated:** 07/12/2016