Provider Demographics
NPI:1053861310
Name:CARTER, OTISHA LA'SHAY
Entity Type:Individual
Prefix:MISS
First Name:OTISHA
Middle Name:LA'SHAY
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 STANDIFER AVE APT A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-5455
Mailing Address - Country:US
Mailing Address - Phone:318-557-2869
Mailing Address - Fax:
Practice Address - Street 1:831 STANDIFER AVE APT A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-5455
Practice Address - Country:US
Practice Address - Phone:318-557-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator