Provider Demographics
NPI:1922206432
Name:HYNES, CARLA JEAN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JEAN
Last Name:HYNES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 SEIB RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-9253
Mailing Address - Country:US
Mailing Address - Phone:812-867-2974
Mailing Address - Fax:
Practice Address - Street 1:650 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3306
Practice Address - Country:US
Practice Address - Phone:812-425-5243
Practice Address - Fax:812-424-1011
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000250A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist