Basic Information
| Provider Information | |||||||||
| NPI: | 1922519115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FULDA | ||||||||
| FirstName: | DEVAN | ||||||||
| MiddleName: | RAELEE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 755 HAYWOOD RD STE H | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288063132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287745222 | ||||||||
| FaxNumber: | 8287745254 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 BERMUDA BAY BLVD | ||||||||
| Address2: | |||||||||
| City: | KILL DEVIL HILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279489537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524894682 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2017 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 10409 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.