1336126382 NPI number — MR. BRETT TERILL DUFFEY SR. OT L

Table of content: MR. BRETT TERILL DUFFEY SR. OT L (NPI 1336126382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336126382 NPI number — MR. BRETT TERILL DUFFEY SR. OT L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUFFEY
Provider First Name:
BRETT
Provider Middle Name:
TERILL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
OT L
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336126382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 MEADOWBROOK MALL
Provider Second Line Business Mailing Address:
SUITE #22
Provider Business Mailing Address City Name:
CLEMMONS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27012-8977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-778-0292
Provider Business Mailing Address Fax Number:
336-778-0292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 MEADOWBROOK MALL CT
Provider Second Line Business Practice Location Address:
SUITE #22
Provider Business Practice Location Address City Name:
CLEMMONS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27012-8112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-778-0292
Provider Business Practice Location Address Fax Number:
336-778-0292
Provider Enumeration Date:
12/29/2005

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:  3857 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10378967 . This is a "NC VOCATIONAL REHAB" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 11-3670557 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 805848 . This is a "PAARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: E2197 . This is a "MEDCOST PREFERRED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0517000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 10378967 . This is a "NC VOCATIONAL REHABILITAT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 135VA . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 64-01026 . This is a "SECURE HORIZONS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 805848 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 691687 . This is a "ACN GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: BA1238 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 007517787 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 136VA . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7301751 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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