MEDICARE: DR. CARRIE MARIE WHEELER MOT, OTD

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	12507	FL
2	225XP0200X	Pediatric Occupational Therapist	6736	NC
3	225X00000X	Occupational Therapist	002067	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801930136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE MARIE WHEELER MOT, OTD

Provider Business Mailing Address
First Line	:	405 SE 11TH ST
Second Line	:
City	:	ANKENY
State	:	IA
Zip	:	50021-3707
Country	:	US
Telephone Number	:	980-939-4795
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 OFFICE PARK RD STE 100
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2548
Country	:	US
Telephone Number	:	515-224-0979
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	10/21/2011

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Directions to “ DR. CARRIE MARIE WHEELER MOT, OTD” Practice Location

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