Provider Demographics
NPI:1437210085
Name:NAYLOR, CARRIE LEEANN (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEEANN
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LEEANN
Other - Last Name:SEIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394-0948
Mailing Address - Country:US
Mailing Address - Phone:541-563-5114
Mailing Address - Fax:541-563-6590
Practice Address - Street 1:220 NW SPRING STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394
Practice Address - Country:US
Practice Address - Phone:541-563-5114
Practice Address - Fax:541-563-6590
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297190Medicaid
OR297190Medicaid