Provider Demographics
NPI:1922388305
Name:NANNY, CARL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:NANNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 W KIEHL AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-2815
Mailing Address - Country:US
Mailing Address - Phone:678-571-0033
Mailing Address - Fax:678-802-7401
Practice Address - Street 1:297 W KIEHL AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-2815
Practice Address - Country:US
Practice Address - Phone:678-571-0033
Practice Address - Fax:678-802-7401
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-1120224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant