MEDICARE: TERESA ELAINE MURRELL OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	10571	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	397730042	OTHER	NC	NSC #

General Provider Information

NPI Number	:	1275516429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ELAINE MURRELL OTR

Provider Business Mailing Address
First Line	:	4601 PARK RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2290
Country	:	US
Telephone Number	:	704-323-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 KIMEL PARK DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6946
Country	:	US
Telephone Number	:	336-765-7058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	02/24/2022

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