Provider Demographics
NPI:1982088068
Name:MA, CARRIE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21405 18TH AVE
Mailing Address - Street 2:3RD APT
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1604
Mailing Address - Country:US
Mailing Address - Phone:718-690-0566
Mailing Address - Fax:
Practice Address - Street 1:21405 18TH AVE
Practice Address - Street 2:3RD APT
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1604
Practice Address - Country:US
Practice Address - Phone:718-690-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019380225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist