Provider Demographics
NPI:1265690200
Name:CARR, CHARLENE A (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:CARR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 DUDLEY OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-5752
Mailing Address - Country:US
Mailing Address - Phone:508-943-0297
Mailing Address - Fax:
Practice Address - Street 1:5 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1407
Practice Address - Country:US
Practice Address - Phone:508-366-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant