Complete Rehab

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

COMPLETE REHAB

Practice address

6000 Meadow Brook Mall
Suite 22
Clemmons, NC 27012-8775

Phone

(336) 778-0292

Fax

(336) 778-0242

NPI assigned

Aug 14, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Jean P Davenport

Title

Office MGR

Phone

(336) 778-0292

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brett Terill Duffey Sr., OT L

  • Occupational Therapist
  • Clemmons, NC
  • NPI 1336126382
  Medicare reassignment NPD
• Diego Fernando Herrera Gutierrez, OTR/L

  • Physical Rehabilitation Occupational Therapist
  • Clemmons, NC
  • NPI 1710583398

  Single Specialty

  NPD
• Samantha Puckett, OTR/L

  • Occupational Therapist
  • Clemmons, NC
  • NPI 1750108718
  NPD
• Monica Shawntae Lackey, OTR/L

  • Occupational Therapist
  • Mocksville, NC
  • NPI 1891254199
  NPD (past)

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1699967547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 MEADOW BROOK MALL",
            "address_2": "SUITE 22",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128775",
            "telephone_number": "336-778-0292",
            "fax_number": "336-778-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 MEADOW BROOK MALL",
            "address_2": "SUITE 22",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128775",
            "telephone_number": "336-778-0292",
            "fax_number": "336-778-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-14",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OFFICE MGR",
        "authorized_official_telephone_number": "336-778-0292",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "135VA",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURE HORIZONS",
            "identifier": "64-01026",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN GROUP",
            "identifier": "691687",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC VOCATIONAL REHAB",
            "identifier": "10378967",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0517000",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7301751",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "805848",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "BA1238",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cmba LLC (Brookstone Terrace)
• Phyllis Patricia Coconis, NP
• Mary Ann Coffey, R.PH
• Rachel Anne Bostic Collins
• Glen Edward Combs, P.A.
• Cornerstone Health Care PA (Mothershed Mothershed Arne Cates & Cane)
• Dylan William Cortese, BS, MSPAS, PA-C
• Marina Coutros, RBT
• Jason Malcolm Crandell, M.D.
• Charles Edward Craven Jr., M.D.

• Occupational Therapist in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.