Provider Demographics
NPI:1134465313
Name:MCLAIN, CARMEN ALVAREZ (OTR)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:ALVAREZ
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:ELISHA
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:12425 PREACHER POWELL RD
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-9243
Mailing Address - Country:US
Mailing Address - Phone:769-926-1685
Mailing Address - Fax:225-275-1201
Practice Address - Street 1:12425 PREACHER POWELL RD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-9243
Practice Address - Country:US
Practice Address - Phone:769-926-1685
Practice Address - Fax:225-275-1201
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12485225X00000X, 225XE0001X, 225XG0600X, 225XL0004X, 225XM0800X, 225XN1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSOT3021OtherMISSISSIPPI STATE DEPARTMENT OF HEALTH
LAOTTZ.12485OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS
MD004240OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY