Healthcare Provider Details

I. General information

NPI: 1255797270
Provider Name (Legal Business Name): DOUGLAS LAWLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16405 NORTHCROSS DR SUITE G-2
HUNTERSVILLE NC
28078-5091
US

IV. Provider business mailing address

16405 NORTHCROSS DR SUITE G-2
HUNTERSVILLE NC
28078-5091
US

V. Phone/Fax

Practice location:
  • Phone: 866-214-9644
  • Fax:
Mailing address:
  • Phone: 866-214-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2014030456
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: