Provider Demographics
NPI:1932971215
Name:RICHARDSON, CARLY REED (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:REED
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E CALGARY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5648
Mailing Address - Country:US
Mailing Address - Phone:701-355-6044
Mailing Address - Fax:
Practice Address - Street 1:1000 E CALGARY AVE STE 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5648
Practice Address - Country:US
Practice Address - Phone:701-355-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2056225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist