Provider Demographics
NPI:1518483858
Name:DUGGAN, CARLY BLAKELY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:BLAKELY
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ELYSE
Other - Last Name:BLAKELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:615-614-8833
Mailing Address - Fax:615-614-8811
Practice Address - Street 1:855 W COLLEGE ST STE F
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2762
Practice Address - Country:US
Practice Address - Phone:615-614-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist