Provider Demographics
NPI:1780929323
Name:ANTLITZ, CARRIE JAMESON (BA, MSOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JAMESON
Last Name:ANTLITZ
Suffix:
Gender:F
Credentials:BA, MSOT, OTR/L
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:SUZANNE
Other - Last Name:JAMESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MSOT, OTR/L
Mailing Address - Street 1:2701 N ROCKY POINT DR STE 650
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5999
Mailing Address - Country:US
Mailing Address - Phone:530-242-1511
Mailing Address - Fax:
Practice Address - Street 1:2516 GOODWATER AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1559
Practice Address - Country:US
Practice Address - Phone:530-242-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10148225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist