Provider Demographics
NPI:1124116587
Name:GURLEY, DOUGLAS SCOTT (OTRL)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:GURLEY
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:MR
Other - First Name:DOUGLAS
Other - Middle Name:SCOTT
Other - Last Name:GURLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:2222 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7515
Mailing Address - Country:US
Mailing Address - Phone:910-343-8209
Mailing Address - Fax:910-343-8836
Practice Address - Street 1:2222 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7515
Practice Address - Country:US
Practice Address - Phone:910-343-8209
Practice Address - Fax:910-343-8836
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211634Medicaid
346639Medicare ID - Type Unspecified