Provider Demographics
NPI:1407970791
Name:CARNAHAN THERAPY THE WORK CENTER, INC.
Entity Type:Organization
Organization Name:CARNAHAN THERAPY THE WORK CENTER, INC.
Other - Org Name:CARNAHAN OCCUPATIONAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARNAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-735-3714
Mailing Address - Street 1:805 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7027
Mailing Address - Country:US
Mailing Address - Phone:805-737-4604
Mailing Address - Fax:805-737-4606
Practice Address - Street 1:217 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2830
Practice Address - Country:US
Practice Address - Phone:805-737-4604
Practice Address - Fax:805-737-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6428A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGCT000250Medicaid
CAW15130Medicare ID - Type UnspecifiedMEDICARE GROUP PROV #