Provider Demographics
NPI:1023155165
Name:CARTER, ANGELA RAE (OTR)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAE
Last Name:CARTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4402
Mailing Address - Country:US
Mailing Address - Phone:619-741-8676
Mailing Address - Fax:
Practice Address - Street 1:9111 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-4402
Practice Address - Country:US
Practice Address - Phone:619-741-8676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4969225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN1011578Medicare ID - Type UnspecifiedCA MEDICARE PROVIDER NUMB