Healthcare Provider Details

I. General information

NPI: 1811783491
Provider Name (Legal Business Name): CARLEY WILHARM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 05/07/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 LESTER DR NE
ALBUQUERQUE NM
87112-2607
US

IV. Provider business mailing address

628 KESSLER DR
NEENAH WI
54956-4114
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-4808
  • Fax:
Mailing address:
  • Phone: 920-716-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030111
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2025-0074
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: