Provider Demographics
NPI:1417091026
Name:FIELDS, MICHELE (OTRL)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 CAPUA CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7011
Mailing Address - Country:US
Mailing Address - Phone:919-493-7002
Mailing Address - Fax:919-403-1407
Practice Address - Street 1:3514 UNIVERSITY DR
Practice Address - Street 2:OFFICE #8
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6247
Practice Address - Country:US
Practice Address - Phone:919-493-7002
Practice Address - Fax:919-403-1407
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0968225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14374OtherBCBSNC