Provider Demographics
NPI:1225718703
Name:CARR, ANNALISE
Entity Type:Individual
Prefix:
First Name:ANNALISE
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1402
Mailing Address - Country:US
Mailing Address - Phone:973-997-7153
Mailing Address - Fax:
Practice Address - Street 1:70 FULTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1402
Practice Address - Country:US
Practice Address - Phone:973-997-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1160924225X00000X
NH3457225X00000X
VT072.0134132225X00000X
NJ46TR00950700225X00000X
MAOTL14917225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist