Provider Demographics
NPI:1225790736
Name:RYAN, CARRIE (OT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:BURKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1665 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2675 N LIPKEY RD
Practice Address - Street 2:
Practice Address - City:NORTH JACKSON
Practice Address - State:OH
Practice Address - Zip Code:44451-9649
Practice Address - Country:US
Practice Address - Phone:330-538-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT006150225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist