Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP008636 | PA |
NPI | 1013410109 |
---|---|
Provider Name | Desiree Lynn Carlin |
First Address | Emmaus, PA 18049-1927 |
Second Address | South Abington Township, PA 18411-1628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OP008636 | COTA/L (01) | PA |