Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTT.Z12485 | LA |
N | 225XE0001X | Environmental Modification | OTT.Z12485 | LA |
N | 225XG0600X | Occupational Therapist - Gerontology | OTT.Z12485 | LA |
N | 225XL0004X | Low Vision | OTT.Z12485 | LA |
N | 225XM0800X | Mental Health | OTT.Z12485 | LA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OTT.Z12485 | LA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTT.Z12485 | LA |
NPI | 1134465313 |
---|---|
Provider Name | Ms. Carmen Alvarez Mclain |
First Address | Carriere, MS 39426-9243 |
Second Address | Carriere, MS 39426-9243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2012 |
Last Update Date | 16/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004240 | NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY (01) | MD |
OT3021 | MISSISSIPPI STATE DEPARTMENT OF HEALTH (01) | MS |
OTTZ.12485 | LOUISIANA STATE BOARD OF MEDICAL EXAMINERS (01) | LA |