Provider Demographics
NPI:1639363351
Name:MCCLUNG, TERESA M (COTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 FRONT ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-9328
Mailing Address - Country:US
Mailing Address - Phone:252-717-5808
Mailing Address - Fax:
Practice Address - Street 1:812 SHEPARD ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4250
Practice Address - Country:US
Practice Address - Phone:252-726-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3799224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant