Provider Demographics
NPI:1033586227
Name:PRATT, CARLY I (COTA/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:I
Last Name:PRATT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N GLENN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5088
Mailing Address - Country:US
Mailing Address - Phone:253-740-3177
Mailing Address - Fax:
Practice Address - Street 1:502 N GLENN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5088
Practice Address - Country:US
Practice Address - Phone:253-740-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60570760224Z00000X
IDOTA-1494224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant