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General NPI Number Information
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NPI Number | 1962103119
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Entity Type | Individual
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Provider Name | KARL CARSON OTR/L
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Gender | Male
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 1910 REED ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-4637
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Country | US
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Telephone | 585-507-8125
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Fax | 484-848-5181
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Provider Business Mailing Address
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Address Line | 108 E BEECHWOOD AVE
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City | OAKLYN
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State | NJ
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Zip | 08107-1321
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Country | US
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Telephone |
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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 | OC004253L
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License Number State | PA
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