Prime Occupational Therapy PLLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

4262 Issued in NC

Legal business name

PRIME OCCUPATIONAL THERAPY PLLC

Practice address

1004 Peony CT
Knightdale, NC 27545-7051

Phone

(919) 539-8661

Fax

(919) 373-9564

NPI assigned

Jul 12, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Mahtsente Worku Ebron, MSHS OTR/L

Title

Occupational Therapist

Phone

(919) 539-8661

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468281600000",
    "number": "1780036988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 PEONY CT",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457051",
            "telephone_number": "919-539-8661",
            "fax_number": "919-373-9564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 PEONY CT",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457051",
            "telephone_number": "919-539-8661",
            "fax_number": "919-373-9564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME OCCUPATIONAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-12",
        "last_updated": "2016-07-12",
        "status": "A",
        "authorized_official_last_name": "EBRON",
        "authorized_official_first_name": "MAHTSENTE",
        "authorized_official_middle_name": "WORKU",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "919-539-8661",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSHS OTR/L"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NC",
            "license": "4262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Disabilities Residential Treatment Facility in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Physical Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; 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.