Provider Demographics
NPI:1336126382
Name:DUFFEY, BRETT TERILL SR (OT L)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:TERILL
Last Name:DUFFEY
Suffix:SR
Gender:M
Credentials:OT L
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 MEADOWBROOK MALL
Mailing Address - Street 2:SUITE #22
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8977
Mailing Address - Country:US
Mailing Address - Phone:336-778-0292
Mailing Address - Fax:336-778-0292
Practice Address - Street 1:6000 MEADOWBROOK MALL CT
Practice Address - Street 2:SUITE #22
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8112
Practice Address - Country:US
Practice Address - Phone:336-778-0292
Practice Address - Fax:336-778-0292
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10378967OtherNC VOCATIONAL REHAB
NC11-3670557OtherCIGNA HEALTHCARE
NC805848OtherPAARTNERS
NCE2197OtherMEDCOST PREFERRED
NC0517000OtherUNITED HEALTH CARE
NC10378967OtherNC VOCATIONAL REHABILITAT
NC135VAOtherBCBSNC
NC64-01026OtherSECURE HORIZONS
NC805848OtherPARTNERS
NC691687OtherACN GROUP
NCBA1238OtherMEDCOST
NC007517787OtherAETNA
NC136VAOtherBCBSNC
NC7301751Medicaid
NC136VAOtherBCBSNC
NC2505259Medicare ID - Type Unspecified