Provider Demographics
NPI:1790056950
Name:NOLAN, CARLA (COTA/L)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:CONCEICAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:10402 AKRON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5003
Mailing Address - Country:US
Mailing Address - Phone:352-942-7521
Mailing Address - Fax:
Practice Address - Street 1:10402 AKRON ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5003
Practice Address - Country:US
Practice Address - Phone:352-942-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12055224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant