Healthcare Provider Details

I. General information

NPI: 1851592539
Provider Name (Legal Business Name): AMY ELIZABETH CARTER O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BARAGA AVE
LANSE MI
49946-1409
US

IV. Provider business mailing address

15696 REBECCA LANE
L'ANSE MI
49946
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-6142
  • Fax:
Mailing address:
  • Phone: 906-424-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201000064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: