Provider Demographics
NPI:1154200947
Name:KISSEL, CARLA (OTR)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:KISSEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13033 SPURGEON RD
Mailing Address - Street 2:
Mailing Address - City:LYNNVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47619-8069
Mailing Address - Country:US
Mailing Address - Phone:812-455-3066
Mailing Address - Fax:
Practice Address - Street 1:13033 SPURGEON RD
Practice Address - Street 2:
Practice Address - City:LYNNVILLE
Practice Address - State:IN
Practice Address - Zip Code:47619-8069
Practice Address - Country:US
Practice Address - Phone:812-455-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003334A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist