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General NPI Number Information
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NPI Number | 1679169346
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Entity Type | Individual
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Provider Name | LISA DEVERE CARR OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 164 NURSING HOME CIR
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3117
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Country | US
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Telephone | 706-745-4948
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Fax |
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Provider Business Mailing Address
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Address Line | 426 OVERLOOK CIR
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7212
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Country | US
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Telephone | 678-520-7291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5521
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3888
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 20090
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3888
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT004384
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License Number State | GA
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