Provider Demographics
NPI:1407571193
Name:APPLEGATE, CARRIE (OTR)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-4419
Mailing Address - Country:US
Mailing Address - Phone:574-333-9747
Mailing Address - Fax:574-367-2369
Practice Address - Street 1:1220 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4419
Practice Address - Country:US
Practice Address - Phone:574-333-9747
Practice Address - Fax:574-367-2369
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist