Organization
INDEPENDENCE REHABILITATION SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WILLIS (PRESIDENT)
(910) 297-6067
Entity
Organization
Contact information
Practice address
3109 WICKFORD DR, WILMINGTON, NC 28409-8531
(910) 790-2869
Mailing address
3109 WICKFORD DR, WILMINGTON, NC 28409-8531
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1237
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7301005
—
NC
Enumeration date
02/08/2007
Last updated
08/22/2020
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