Provider Demographics
NPI:1548770803
Name:HART, CARLA (OTR)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SMOKEBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-0739
Mailing Address - Country:US
Mailing Address - Phone:707-208-0843
Mailing Address - Fax:
Practice Address - Street 1:1101 CENTRAL EXPY S
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8131
Practice Address - Country:US
Practice Address - Phone:707-208-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2017-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118565225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation