Healthcare Provider Details

I. General information

NPI: 1629012018
Provider Name (Legal Business Name): MICHAEL DAVID CALHOUN OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 N. CROATAN HWY. STE 3, 2ND FLOOR
KILL DEVIL HILLS NC
27948-8516
US

IV. Provider business mailing address

PO BOX 7393
KILL DEVIL HILLS NC
27948-7393
US

V. Phone/Fax

Practice location:
  • Phone: 252-255-5252
  • Fax: 252-480-0943
Mailing address:
  • Phone: 252-255-5252
  • Fax: 252-480-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2161NC
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: