Provider Demographics
NPI:1053556738
Name:LIVELY, THERESA DULSKI (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DULSKI
Last Name:LIVELY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3651
Mailing Address - Country:US
Mailing Address - Phone:919-878-6730
Mailing Address - Fax:
Practice Address - Street 1:3100 PIEDMONT DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3651
Practice Address - Country:US
Practice Address - Phone:919-878-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist