Provider Demographics
NPI:1124271317
Name:OSBORNE, CARLY LYNN I (MS,OTR/L)
Entity type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:LYNN
Last Name:OSBORNE
Suffix:I
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159-39 91ST STREET
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3119
Mailing Address - Country:US
Mailing Address - Phone:646-872-9436
Mailing Address - Fax:718-949-5242
Practice Address - Street 1:162-11 96TH STREET
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3119
Practice Address - Country:US
Practice Address - Phone:718-835-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010451-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor