Organization
OT4 KIDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL FRYE STEPHENS OTR/L (PRESIDENT)
(336) 236-6546
Entity
Organization
Contact information
Practice address
440 CENTRAL AVENUE, LEXINGTON, NC 27292-2634
(336) 236-6546
(336) 236-9546
Mailing address
PO BOX 587, LEXINGTON, NC 27293-0587
(336) 236-6546
(336) 236-9546
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1164
NC
225X00000X
Occupational Therapist
Primary
0149
NC
235Z00000X
Speech-Language Pathologist
8820
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68681
BCBSNC
NC
05
—
7211679
—
NC
Enumeration date
02/10/2006
Last updated
03/05/2012
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