Provider Demographics
NPI:1972673580
Name:MITCHELL, CARRIE (OT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 CANAL STREET
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064
Mailing Address - Country:US
Mailing Address - Phone:603-882-6333
Mailing Address - Fax:603-889-5460
Practice Address - Street 1:144 CANAL STREET
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064
Practice Address - Country:US
Practice Address - Phone:603-882-6333
Practice Address - Fax:603-889-5460
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7848225X00000X
NH1597225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH13Y010015NH01OtherBCBS
NH272746OtherCIGNA
NH99560056Medicaid
NH561822OtherAETNA
NH761242OtherTUFTS
NH626514OtherHARVARD PILGRIM