Provider Demographics
NPI:1255560074
Name:O'GUIN, CARLA LEE
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:LEE
Last Name:O'GUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 GENE WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-9002
Mailing Address - Country:US
Mailing Address - Phone:989-666-4324
Mailing Address - Fax:
Practice Address - Street 1:1415 GENE WILSON BLVD
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9002
Practice Address - Country:US
Practice Address - Phone:989-666-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist