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NPI Code Detail

MEDICARE: LISA DEVERE CARR OTR/L

MEDICARE: LISA DEVERE CARR 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
1225X00000XOccupational Therapist5521AL
2225X00000XOccupational Therapist3888NC
3225X00000XOccupational Therapist20090FL
4225X00000XOccupational Therapist3888FL
5225X00000XOccupational TherapistOT004384GA

General Provider Information

NPI Number : 1679169346
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA DEVERE CARR OTR/L
Provider Business Mailing Address
First Line : 426 OVERLOOK CIR
Second Line :
City : DAWSONVILLE
State : GA
Zip : 30534-7212
Country : US
Telephone Number : 678-520-7291
Fax Number :
Provider Business Practice Location Address
First Line : 164 NURSING HOME CIR
Second Line :
City : BLAIRSVILLE
State : GA
Zip : 30512-3117
Country : US
Telephone Number : 706-745-4948
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2020
Last Update Date : 08/17/2021

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