Provider Demographics
NPI:1922255892
Name:BURNS, CAROLYN ELLEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELLEN
Last Name:BURNS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELLEN
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3803 FINCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1423
Mailing Address - Country:US
Mailing Address - Phone:502-485-9914
Mailing Address - Fax:
Practice Address - Street 1:3803 FINCASTLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1423
Practice Address - Country:US
Practice Address - Phone:502-485-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-A1988224Z00000X
IN32000765A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant