Healthcare Provider Details

I. General information

NPI: 1619935566
Provider Name (Legal Business Name): MICHELE H. DURHAM O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD STE 304
STUART FL
34994-4512
US

IV. Provider business mailing address

35 INTERNATIONAL DR
GREENVILLE SC
29615-4816
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2400
  • Fax:
Mailing address:
  • Phone: 864-234-7654
  • Fax: 864-675-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1264
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT5399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: