MEDICARE: CARLY MICHELLE CODY 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	10920	NC

General Provider Information

NPI Number	:	1598298838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY MICHELLE CODY OTR/L

Provider Business Mailing Address
First Line	:	536 OLD HOWELL RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-1969
Country	:	US
Telephone Number	:	864-244-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 SIPES ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2716
Country	:	US
Telephone Number	:	704-739-8132
Fax Number	:

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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