Organization
OUR VILLAGE THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L WALTHER MS, OTR/L (EXECUTIVE DIRECTOR)
(919) 417-7259
Entity
Organization
Contact information
Practice address
7316 RIDGE GROVE CT, RALEIGH, NC 27615-5908
(919) 417-7259
Mailing address
7316 RIDGE GROVE CT, RALEIGH, NC 27615-5908
(919) 417-7259
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134462872
—
NC
Enumeration date
10/04/2022
Last updated
10/04/2022
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