Provider Demographics
NPI:1255900197
Name:WARNE, CARLEY
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:WARNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLEY
Other - Middle Name:
Other - Last Name:RUDLOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4554 E INVERNESS AVE STE C-1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4639
Mailing Address - Country:US
Mailing Address - Phone:480-295-4925
Mailing Address - Fax:
Practice Address - Street 1:4554 E INVERNESS AVE STE C-1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4639
Practice Address - Country:US
Practice Address - Phone:480-295-4925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist