Provider Demographics
NPI:1255577425
Name:CARLSON, RYAN ROBERT (OTD, OTR/L)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ROBERT
Last Name:CARLSON
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 S 17TH ST
Mailing Address - Street 2:P.O. BOX 217
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2625
Mailing Address - Country:US
Mailing Address - Phone:712-246-8224
Mailing Address - Fax:
Practice Address - Street 1:1309 SOUTHMORELAND PL
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2247
Practice Address - Country:US
Practice Address - Phone:712-246-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist