Provider Demographics
NPI:1235748393
Name:CARMICHAEL, RENEE K (OTA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:K
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:K
Other - Last Name:CARMCHAEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTA
Mailing Address - Street 1:14005 PROMENADE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6684
Mailing Address - Country:US
Mailing Address - Phone:704-274-5980
Mailing Address - Fax:
Practice Address - Street 1:102 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-9649
Practice Address - Country:US
Practice Address - Phone:828-464-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8999224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant