Provider Demographics
NPI:1427367234
Name:CRIM, CARLYE (COTA)
Entity Type:Individual
Prefix:
First Name:CARLYE
Middle Name:
Last Name:CRIM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10799 BAXTER CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:SHOALS
Mailing Address - State:IN
Mailing Address - Zip Code:47581-7734
Mailing Address - Country:US
Mailing Address - Phone:812-709-2296
Mailing Address - Fax:
Practice Address - Street 1:1764 TROY RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8210
Practice Address - Country:US
Practice Address - Phone:812-254-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000988A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant