MEDICARE: ANNA CARR MOT, OTR/L

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	225X00000X	Occupational Therapist	2016036423	MO

General Provider Information

NPI Number	:	1437693934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CARR MOT, OTR/L

Provider Business Mailing Address
First Line	:	126 W SPRINGFIELD RD
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-1524
Country	:	US
Telephone Number	:	573-468-4900
Fax Number	:	573-468-4901

Provider Business Practice Location Address
First Line	:	126 W SPRINGFIELD RD
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-1524
Country	:	US
Telephone Number	:	573-468-4900
Fax Number	:	573-468-4901

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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