Provider Demographics
NPI:1982839429
Name:OHLENDORF, CARRIE (LMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:OHLENDORF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W MISSISSIPPI
Mailing Address - Street 2:
Mailing Address - City:BARRY
Mailing Address - State:IL
Mailing Address - Zip Code:62312-2428
Mailing Address - Country:US
Mailing Address - Phone:217-617-7696
Mailing Address - Fax:217-285-5157
Practice Address - Street 1:211 W PERRY ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1109
Practice Address - Country:US
Practice Address - Phone:217-285-4122
Practice Address - Fax:217-285-5157
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009012048225700000X
IL227.007838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist