Provider Demographics
NPI:1205693512
Name:CARTER, TRESSIA MICHELLE
Entity type:Individual
Prefix:
First Name:TRESSIA
Middle Name:MICHELLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 S DODSON RD APT F1
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7327
Mailing Address - Country:US
Mailing Address - Phone:870-490-0595
Mailing Address - Fax:
Practice Address - Street 1:2575 GENE GEORGE BLVD STE OO1
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6385
Practice Address - Country:US
Practice Address - Phone:479-750-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist