Provider Demographics
NPI:1801930136
Name:WHEELER, CARRIE MARIE (MOT, OTD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:MARIE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MOT, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-3707
Mailing Address - Country:US
Mailing Address - Phone:980-939-4795
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2548
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12507225XP0200X
NC6736225XP0200X
IA002067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891722100Medicaid