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NPI Code Detail

MEDICARE: CARISSA RUTT OTR

MEDICARE: CARISSA RUTT OTR
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
1225X00000XOccupational TherapistOT00003620WA
2225X00000XOccupational Therapist3167CO

General Provider Information

NPI Number : 1417082116
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA RUTT OTR
Provider Business Mailing Address
First Line : 340 MENDEL PKWY W
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-5406
Country : US
Telephone Number : 334-532-0220
Fax Number :
Provider Business Practice Location Address
First Line : 340 MENDEL PKWY W
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-5406
Country : US
Telephone Number : 334-532-0220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 08/22/2016

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