Provider Demographics
NPI:1356086383
Name:CARLISLE, QUIAN DONALD
Entity Type:Individual
Prefix:
First Name:QUIAN
Middle Name:DONALD
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAGNOLIA GLEN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4278
Mailing Address - Country:US
Mailing Address - Phone:184-324-6229
Mailing Address - Fax:
Practice Address - Street 1:4 MAGNOLIA GLEN LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-4278
Practice Address - Country:US
Practice Address - Phone:184-324-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist