Provider Demographics
NPI:1881368884
Name:PITTS, CARLA PATRICE (OT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:PATRICE
Last Name:PITTS
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 1:427 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2148
Mailing Address - Country:US
Mailing Address - Phone:662-560-6865
Mailing Address - Fax:
Practice Address - Street 1:90A CLARK ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4812
Practice Address - Country:US
Practice Address - Phone:662-840-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist