Provider Demographics
NPI:1710934351
Name:SERADGE, CARRIE C (OT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:C
Last Name:SERADGE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SW 44TH ST
Mailing Address - Street 2:SUITE 518
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3609
Mailing Address - Country:US
Mailing Address - Phone:405-634-4263
Mailing Address - Fax:405-634-4267
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:SUITE 518
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3613
Practice Address - Country:US
Practice Address - Phone:405-634-4263
Practice Address - Fax:405-634-4267
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK647225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand