Healthcare Provider Details

I. General information

NPI: 1386570133
Provider Name (Legal Business Name): MENDED MOTHER OT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N ST STE 102
ANCHORAGE AK
99501-3285
US

IV. Provider business mailing address

821 N ST STE 102
ANCHORAGE AK
99501-3285
US

V. Phone/Fax

Practice location:
  • Phone: 907-312-5564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARRIE L PORTER
Title or Position: FOUNDER
Credential: OTD, OTR/L, COMT-UL
Phone: 915-539-0328