Provider Demographics
NPI:1922519115
Name:FULDA, DEVAN RAELEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:RAELEE
Last Name:FULDA
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 1:755 HAYWOOD RD STE H
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3132
Mailing Address - Country:US
Mailing Address - Phone:828-774-5222
Mailing Address - Fax:828-774-5254
Practice Address - Street 1:803 BERMUDA BAY BLVD
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9537
Practice Address - Country:US
Practice Address - Phone:252-489-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist