Provider Demographics
NPI:1558121699
Name:STAINBACK, CARRLEE DELORES (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARRLEE
Middle Name:DELORES
Last Name:STAINBACK
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 1:805 OAKHURST DR STE A
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3712
Mailing Address - Country:US
Mailing Address - Phone:706-831-1128
Mailing Address - Fax:770-230-0157
Practice Address - Street 1:805 OAKHURST DR STE A
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3712
Practice Address - Country:US
Practice Address - Phone:706-831-1128
Practice Address - Fax:770-230-0157
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist