Provider Demographics
NPI:1497017859
Name:CARTER, CYNTHIA FUNK (OT/L, CLT-LANA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:FUNK
Last Name:CARTER
Suffix:
Gender:F
Credentials:OT/L, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3029
Mailing Address - Country:US
Mailing Address - Phone:785-424-7041
Mailing Address - Fax:
Practice Address - Street 1:325 MAINE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1360
Practice Address - Country:US
Practice Address - Phone:785-505-2712
Practice Address - Fax:785-505-2889
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist