Provider Demographics
NPI:1871165878
Name:NEUROGENESIS THERAPY
Entity type:Organization
Organization Name:NEUROGENESIS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:DORA
Authorized Official - Last Name:QUILTY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:703-980-6021
Mailing Address - Street 1:4104 HAMPTON PARK WAY
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5475
Mailing Address - Country:US
Mailing Address - Phone:703-980-6021
Mailing Address - Fax:
Practice Address - Street 1:4104 HAMPTON PARK WAY
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5475
Practice Address - Country:US
Practice Address - Phone:703-980-6021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty