Provider Demographics
NPI:1225460496
Name:LEVERONE, CARLYN MICHELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLYN
Middle Name:MICHELLE
Last Name:LEVERONE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CARLYN
Other - Middle Name:MICHELLE
Other - Last Name:ROBBOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:11407 HUNTERS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-8810
Mailing Address - Country:US
Mailing Address - Phone:585-313-0073
Mailing Address - Fax:
Practice Address - Street 1:8919 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-9600
Practice Address - Country:US
Practice Address - Phone:704-551-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012814225X00000X
NY018520225X00000X
NC11063225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355344Medicaid