James Pruitt

Individual provider Active NPI Occupational Therapy Assistant · Newport, NC

NPI 1104307669 · NPPES record last updated Aug 23, 2018

Key facts

NPI
1104307669
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
11553 (NC)
Practice address
210 Foxhall Rd
Newport, NC 28570-6790
Phone
(252) 223-2560
NPI assigned
Aug 23, 2018
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
11553NCMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 11553 NC Yes

Addresses

Primary practice location

210 Foxhall Rd
Newport, NC 28570-6790

Mailing address

504 Maize CT
Hubert, NC 28539-4075

Other providers in Newport, NC

All providers in Newport, NC · Occupational Therapy Assistant in North Carolina

Sources for this page

Verify at the official NPI Registry.