Healthcare Provider Details

I. General information

NPI: 1134465313
Provider Name (Legal Business Name): CARMEN ALVAREZ MCLAIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARMEN ELISHA ALVAREZ OTR

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 PREACHER POWELL RD
CARRIERE MS
39426-9243
US

IV. Provider business mailing address

12425 PREACHER POWELL RD
CARRIERE MS
39426-9243
US

V. Phone/Fax

Practice location:
  • Phone: 769-926-1685
  • Fax: 225-275-1201
Mailing address:
  • Phone: 769-926-1685
  • Fax: 225-275-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.Z12485
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberOTT.Z12485
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOTT.Z12485
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License NumberOTT.Z12485
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberOTT.Z12485
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOTT.Z12485
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTT.Z12485
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: