Provider Demographics
NPI:1649690876
Name:GAWRYLUK, MICHELE RENEE (OTR)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEE
Last Name:GAWRYLUK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 JOHN BOONE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6720
Mailing Address - Country:US
Mailing Address - Phone:843-884-6949
Mailing Address - Fax:843-849-5285
Practice Address - Street 1:937 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3336
Practice Address - Country:US
Practice Address - Phone:843-883-6949
Practice Address - Fax:843-849-5285
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC001997172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker