Provider Demographics
NPI:1770935504
Name:LEWIS-RAHHAL, CARRIE ILENE (COTA/L)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ILENE
Last Name:LEWIS-RAHHAL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MIZZEN CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1780
Mailing Address - Country:US
Mailing Address - Phone:757-236-3451
Mailing Address - Fax:
Practice Address - Street 1:54 MIZZEN CIR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-1780
Practice Address - Country:US
Practice Address - Phone:757-236-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02348224Z00000X
VA0131001123224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant