Provider Demographics
NPI:1164534707
Name:BOOTH, CARRIE B (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:BOOTH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:B
Other - Last Name:STOLZENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:830 S ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2877
Mailing Address - Country:US
Mailing Address - Phone:630-620-4433
Mailing Address - Fax:630-620-1148
Practice Address - Street 1:830 S ADDISON AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2877
Practice Address - Country:US
Practice Address - Phone:630-620-4433
Practice Address - Fax:630-620-1148
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-007761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist