Organization
EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JELORE LITTLE (DIR, CONTRACTS & CREDENTIALING)
(336) 545-6338
Entity
Organization
Contact information
Practice address
10510 MALLARD CREEK ROAD, SUITE 510, CHARLOTTE, NC 28262
(704) 333-8220
(704) 333-7066
Mailing address
5171 GLENWOOD AVE, SUITE 400, RALEIGH, NC 27612-3266
(919) 783-8898
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
720282G
—
NC
Enumeration date
02/02/2007
Last updated
01/17/2020
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