Provider Demographics
NPI:1205213352
Name:MCDUFFIE, KAHLIE BRIANNE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KAHLIE
Middle Name:BRIANNE
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:KAHLIE
Other - Middle Name:BRIANNE
Other - Last Name:TOMPLAIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 S FRANKLIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2797
Mailing Address - Country:US
Mailing Address - Phone:919-556-1700
Mailing Address - Fax:919-556-1245
Practice Address - Street 1:900 S FRANKLIN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2797
Practice Address - Country:US
Practice Address - Phone:919-556-1700
Practice Address - Fax:919-556-1245
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9574225X00000X
AL3770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist