Provider Demographics
NPI:1649603911
Name:CANTERBURY, CARLING MOSES (OT)
Entity type:Individual
Prefix:
First Name:CARLING
Middle Name:MOSES
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MIDDLETON RD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-2021
Mailing Address - Country:US
Mailing Address - Phone:662-845-4399
Mailing Address - Fax:
Practice Address - Street 1:627 MIDDLETON RD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2021
Practice Address - Country:US
Practice Address - Phone:662-845-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2974225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist