Organization
RALEIGH OT LLC
Active
Organization
RALEIGH OT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB HAWKINS (OWNER)
(801) 739-3787
Entity
Organization
Contact information
Practice address
4912 SWEET SHADE TRL, RALEIGH, NC 27616-4652
(801) 739-3787
Mailing address
4912 SWEET SHADE TRL, RALEIGH, NC 27616-4652
(801) 739-3787
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XE1200X
Ergonomics Occupational Therapist
—
—
225XG0600X
Gerontology Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
05/30/2025
Last updated
05/30/2025
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