MEDICARE: AMY CARLETON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	103530	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16154051	OTHER	MN	PT CARE
2	169036	OTHER	MN	UCARE
3	565581028803	OTHER	MN	PREFERRED ONE
4	1311578	OTHER	MN	ARAZ/AMERICA'S PPO/CIGNA
5	76842	OTHER	MN	HEALTH PARTNERS
6	78B64KI	OTHER	MN	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063965507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CARLETON

Provider Business Mailing Address
First Line	:	PO BOX 34
Second Line	:	1772 STIEGER LAKE LANE
City	:	VICTORIA
State	:	MN
Zip	:	55386-0034
Country	:	US
Telephone Number	:	952-443-9888
Fax Number	:	952-443-9804

Provider Business Practice Location Address
First Line	:	8758 EGAN DR
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-2561
Country	:	US
Telephone Number	:	952-443-9888
Fax Number	:	952-443-9804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	11/10/2016

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Directions to “ AMY CARLETON ” Practice Location

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