Organization
JABULANI KIDS PEDIATRIC THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW JAMES SILVER (CFO)
(336) 793-3253
Entity
Organization
Contact information
Practice address
1130 SNOW BRIDGE LN, SUITE C, KERNERSVILLE, NC 27284-8411
(336) 310-5828
(888) 511-1230
Mailing address
PO BOX 2061, KERNERSVILLE, NC 27285-2061
(336) 310-5828
(888) 511-1230
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4696
NC
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
4696
NC
225XM0800X
Mental Health Occupational Therapist
4696
NC
225XP0200X
Pediatric Occupational Therapist
4696
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148A7
BCBS
NC
05
—
7302077
—
NC
Enumeration date
05/29/2014
Last updated
12/08/2015
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