Provider Demographics
NPI:1083006134
Name:PRATT, CAROL (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E. MICHIGAN AVE
Mailing Address - Street 2:OUTPATIENT REHAB - LOWER LEVEL
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-364-5252
Mailing Address - Fax:517-364-5296
Practice Address - Street 1:1200 E. MICHIGAN AVE
Practice Address - Street 2:OUTPATIENT REHAB - LOWER LEVEL
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-5252
Practice Address - Fax:517-364-5296
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000159225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist