Provider Demographics
NPI:1457083578
Name:CHULOCK, CARLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:CHULOCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 BERWICK VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8111
Mailing Address - Country:US
Mailing Address - Phone:203-631-3686
Mailing Address - Fax:
Practice Address - Street 1:1217 BERWICK VALLEY LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8111
Practice Address - Country:US
Practice Address - Phone:203-631-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist