Provider Demographics
NPI:1073927604
Name:LIVESAY, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:LIVESAY
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 1:3180 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7915
Mailing Address - Country:US
Mailing Address - Phone:901-328-2110
Mailing Address - Fax:901-590-3999
Practice Address - Street 1:3180 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7915
Practice Address - Country:US
Practice Address - Phone:901-328-2110
Practice Address - Fax:901-590-3999
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist