Individual
MR. DARYL PATRICK BOURGEOIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, OTR/L
Contact information
Practice address
554 SECOND STREET, AYDEN, NC 28513-7202
(252) 714-8568
Mailing address
104 BERKSHIRE DR, WINTERVILLE, NC 28590-9105
(252) 259-2012
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7220
NC
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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