Provider Demographics
NPI:1528007200
Name:LITTRELL, MICHAEL (OT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LITTRELL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 ARENDELL STREET
Mailing Address - Street 2:SUITE M
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557
Mailing Address - Country:US
Mailing Address - Phone:252-808-3100
Mailing Address - Fax:252-808-3120
Practice Address - Street 1:4218 ARENDELL STREET
Practice Address - Street 2:SUITE M
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-808-3100
Practice Address - Fax:252-808-3120
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127FGOtherBCBS
NC7301400Medicaid
NC2511841Medicare PIN