Devan Raelee Fulda, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

10409 Issued in NC

Practice address

803 Bermuda Bay Blvd
Kill Devil Hills, NC 27948-9537

Phone

(252) 489-4682

NPI assigned

Oct 16, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1922519115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 HAYWOOD RD STE H",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288063132",
            "telephone_number": "828-774-5222",
            "fax_number": "828-774-5254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 BERMUDA BAY BLVD",
            "city": "KILL DEVIL HILLS",
            "state": "NC",
            "postal_code": "279489537",
            "telephone_number": "252-489-4682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULDA",
        "first_name": "DEVAN",
        "middle_name": "RAELEE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-16",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "10409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Kill Devil Hills, NC
• Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.