Provider Demographics
NPI:1124802152
Name:CARSWELL, IVANIE DIONNE (OTR/L)
Entity type:Individual
Prefix:
First Name:IVANIE
Middle Name:DIONNE
Last Name:CARSWELL
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 1:5208 S 79TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7010
Mailing Address - Country:US
Mailing Address - Phone:813-315-0462
Mailing Address - Fax:
Practice Address - Street 1:5208 S 79TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7010
Practice Address - Country:US
Practice Address - Phone:813-315-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist