Provider Demographics
NPI:1346255163
Name:MURTY-GAMI, SUNITA (MS OTRL)
Entity Type:Individual
Prefix:
First Name:SUNITA
Middle Name:
Last Name:MURTY-GAMI
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 HARP ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1303
Mailing Address - Country:US
Mailing Address - Phone:314-749-9654
Mailing Address - Fax:
Practice Address - Street 1:1179 HARP ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1303
Practice Address - Country:US
Practice Address - Phone:314-749-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
172V00000X, 222Q00000X
NC5739225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
No172V00000XOther Service ProvidersCommunity Health Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13972OtherBCBS
NC7301827Medicaid