=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962092718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY RYAN CARNES OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2021
-----------------------------------------------------
Last Update Date | 01/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3610 SPRINGHILL MEMORIAL DR N
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36608-1162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-410-3690
-----------------------------------------------------
Fax | 251-410-3700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 KENTWOOD WAY
-----------------------------------------------------
City | ALABASTER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35007-5206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-881-9033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5457
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------