Provider Demographics
NPI:1083008726
Name:WORM, CARISSA NAOMI (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:NAOMI
Last Name:WORM
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 1:432 KENDALL HVN
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-5837
Mailing Address - Country:US
Mailing Address - Phone:757-345-9166
Mailing Address - Fax:
Practice Address - Street 1:432 KENDALL HVN
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-5837
Practice Address - Country:US
Practice Address - Phone:757-345-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006560225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation