Provider Demographics
NPI:1235483843
Name:FARLEY, CARLY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:RINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2423 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3614
Mailing Address - Country:US
Mailing Address - Phone:540-336-3273
Mailing Address - Fax:
Practice Address - Street 1:2423 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3614
Practice Address - Country:US
Practice Address - Phone:540-336-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NC8488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist