Healthcare Provider Details

I. General information

NPI: 1679481543
Provider Name (Legal Business Name): AVA ANN TUGGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 LEESVILLE RD STE 123
RALEIGH NC
27613-1062
US

IV. Provider business mailing address

9101 LEESVILLE RD STE 123
RALEIGH NC
27613-1062
US

V. Phone/Fax

Practice location:
  • Phone: 919-629-9208
  • Fax:
Mailing address:
  • Phone: 919-629-9208
  • Fax: 919-364-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18854
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number18854
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: