Provider Demographics
NPI:1649822651
Name:CARNES, VICKIE RENEE (OT/L)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:RENEE
Last Name:CARNES
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:CANNON
Mailing Address - State:KY
Mailing Address - Zip Code:40923-0186
Mailing Address - Country:US
Mailing Address - Phone:606-627-4719
Mailing Address - Fax:
Practice Address - Street 1:80 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7363
Practice Address - Country:US
Practice Address - Phone:606-545-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist