Innovative OT NC LLC

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

Legal business name

INNOVATIVE OT NC LLC

Practice address

412 Fire Opal Lane
Holly Springs, NC 27540

Phone

(919) 244-8367

NPI assigned

May 6, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karen Tracy Johnson, OT

Title

Owner

Phone

(919) 244-8367

Specialties & licenses 1

Addresses

Other names 2

• Innovative OT NC LLC Other name
• Innovative OT NC, LLC Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1124764782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 HOLLY SPRINGS RD STE 148",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275409030",
            "telephone_number": "919-244-8367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 FIRE OPAL LANE",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "27540",
            "telephone_number": "919-244-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE OT NC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-06",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "TRACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-244-8367",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative OT NC LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Innovative OT NC, LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Innovative OT NC, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michael William Hughes, PAC
• Abigail Hulbert, NP
• Vincent A. Iannace, MD
• Manal Ibrahim, PHARMD
• Julia Eden Dietsche Im
• Integrity Clinical Labs
• Kaori Watanabe Isaacson
• T Jackson, APRN
• Sara K Jadi
• Andrew Robert James, DO

• Physical Rehabilitation Occupational Therapist in Holly Springs, NC
• Providers in Holly Springs, NC by specialty
• Physical Rehabilitation Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.