Provider Demographics
NPI:1528359114
Name:MESSNER, CARLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MESSNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1909
Mailing Address - Country:US
Mailing Address - Phone:503-310-2499
Mailing Address - Fax:
Practice Address - Street 1:526 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1909
Practice Address - Country:US
Practice Address - Phone:605-388-2993
Practice Address - Fax:605-546-7166
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist