Provider Demographics
NPI:1649436718
Name:PEDIATRIC POSSIBILITIES
Entity type:Organization
Organization Name:PEDIATRIC POSSIBILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-844-1100
Mailing Address - Street 1:7209 CREEDMOOR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1625
Mailing Address - Country:US
Mailing Address - Phone:919-844-1100
Mailing Address - Fax:919-844-1102
Practice Address - Street 1:8928 US 70 BUS HWY W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4844
Practice Address - Country:US
Practice Address - Phone:919-844-1100
Practice Address - Fax:919-844-1102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC POSSIBILITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0945225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC737489BMedicaid