Provider Demographics
NPI:1821689753
Name:ITALIANO, CARRIE L (OT006754)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:ITALIANO
Suffix:
Gender:F
Credentials:OT006754
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1718
Mailing Address - Country:US
Mailing Address - Phone:330-550-7430
Mailing Address - Fax:
Practice Address - Street 1:192 MORRISON STREET
Practice Address - Street 2:
Practice Address - City:1: STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006754225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist