Provider Demographics
NPI:1386769321
Name:BUSCH, GEORGE DOUGLAS (MS OTR)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:BUSCH
Suffix:
Gender:M
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2069
Mailing Address - Country:US
Mailing Address - Phone:919-383-7585
Mailing Address - Fax:
Practice Address - Street 1:207 N RIVERDALE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-2069
Practice Address - Country:US
Practice Address - Phone:919-383-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2878225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301178Medicaid
NC139CFOtherBCBS OF NC