Provider Demographics
NPI:1811212970
Name:HAMES, CAROL SUE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUE
Last Name:HAMES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:SUE
Other - Last Name:HAMES-HAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1007B NYE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-5759
Mailing Address - Country:US
Mailing Address - Phone:318-769-1669
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:71 NORTH
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200303172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0TT.200303OtherOCCUPATIONAL THERAPIST