Healthcare Provider Details

I. General information

NPI: 1659480358
Provider Name (Legal Business Name): CARRIE LYNN NUTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9416 SKOKIE BLVD
SKOKIE IL
60077
US

IV. Provider business mailing address

1872 N CLYBOURN AVE APT 309
CHICAGO IL
60614-4916
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-4800
  • Fax: 847-673-9322
Mailing address:
  • Phone: 773-472-3834
  • Fax: 773-472-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: