1225223027 NPI number — MRS. MICHELE WELKER GILBREATH OTR/L

Table of content: MRS. MICHELE WELKER GILBREATH OTR/L (NPI 1225223027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225223027 NPI number — MRS. MICHELE WELKER GILBREATH OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBREATH
Provider First Name:
MICHELE
Provider Middle Name:
WELKER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REGENT
Provider Other First Name:
MICHELE
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225223027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3415 MELROSE ROAD
Provider Second Line Business Mailing Address:
SUITE C-1
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-1634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-425-6282
Provider Business Mailing Address Fax Number:
910-425-6554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3415 MELROSE ROAD
Provider Second Line Business Practice Location Address:
SUITE C-1
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-425-6282
Provider Business Practice Location Address Fax Number:
910-425-6554
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2866 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT.003976 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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