Provider Demographics
NPI:1508231119
Name:OSBOURNE, CARRI (LMT, CLT)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:
Last Name:OSBOURNE
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4605
Mailing Address - Country:US
Mailing Address - Phone:937-231-0880
Mailing Address - Fax:
Practice Address - Street 1:1948 E. WHIPP ROAD
Practice Address - Street 2:A2
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-4239
Practice Address - Country:US
Practice Address - Phone:937-231-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018977225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist