Healthcare Provider Details

I. General information

NPI: 1548685977
Provider Name (Legal Business Name): MIA MANNING CARTER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 AZALEA RD
MOBILE AL
36609-1515
US

IV. Provider business mailing address

669 AZALEA RD
MOBILE AL
36609-1515
US

V. Phone/Fax

Practice location:
  • Phone: 251-422-1827
  • Fax: 251-272-7928
Mailing address:
  • Phone: 251-422-1827
  • Fax: 251-272-7928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3722
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3722
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: