Provider Demographics
NPI:1962682674
Name:MALLINSON, CARLA MERRITT (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MERRITT
Last Name:MALLINSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 HIGHWAY 17 BYP
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9301
Mailing Address - Country:US
Mailing Address - Phone:843-650-2213
Mailing Address - Fax:
Practice Address - Street 1:9405 HIGHWAY 17 BYP
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9301
Practice Address - Country:US
Practice Address - Phone:843-650-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2602224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant