Provider Demographics
NPI:1629012018
Name:CALHOUN, MICHAEL DAVID (OTRL)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7393
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-7393
Mailing Address - Country:US
Mailing Address - Phone:252-255-5252
Mailing Address - Fax:252-480-0943
Practice Address - Street 1:3210 N. CROATAN HWY.
Practice Address - Street 2:STE 3, 2ND FLOOR
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-8516
Practice Address - Country:US
Practice Address - Phone:252-255-5252
Practice Address - Fax:252-480-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2161NC225X00000X
NC2161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11387OtherBCBS OF NC
NC182600OtherMEDCOST
NC7301179Medicaid
NCP00316027OtherMEDICARE RAILROAD
NC044180OtherAETNA
NC10391371OtherNC DIV. OF VOCATIONAL REH
NCP00316027OtherMEDICARE RAILROAD
NC7301179Medicaid