Provider Demographics
NPI:1699010835
Name:HENDERSON, CARRIE M (MS OT/L)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1327
Mailing Address - Country:US
Mailing Address - Phone:410-426-8855
Mailing Address - Fax:
Practice Address - Street 1:6040 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1327
Practice Address - Country:US
Practice Address - Phone:410-426-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist