MEDICARE: MR. DAVID MICHAEL CLATTERBUCK OTR/L

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	12746	NC

General Provider Information

NPI Number	:	1407443419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID MICHAEL CLATTERBUCK OTR/L

Provider Business Mailing Address
First Line	:	1705 WESTHAVEN DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-4701
Country	:	US
Telephone Number	:	919-710-1529
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CLYNELISH CLOSE
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-4933
Country	:	US
Telephone Number	:	919-710-1529
Fax Number	:

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

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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