Healthcare Provider Details

I. General information

NPI: 1316122062
Provider Name (Legal Business Name): CARRIE LEE PTACIN MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7990 E SNYDER RD APT 11101
TUCSON AZ
85750-9022
US

IV. Provider business mailing address

7990 E SNYDER RD APT 11101
TUCSON AZ
85750-9022
US

V. Phone/Fax

Practice location:
  • Phone: 520-904-7812
  • Fax:
Mailing address:
  • Phone: 520-904-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number3146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: