Provider Demographics
NPI:1154520781
Name:PURSELL, CARISA GAYLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:CARISA
Middle Name:GAYLE
Last Name:PURSELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:CARISA
Other - Middle Name:GAYLE
Other - Last Name:SONTAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3140 LAUREL LANE
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4108
Mailing Address - Country:US
Mailing Address - Phone:314-276-4201
Mailing Address - Fax:
Practice Address - Street 1:3140 LAUREL LANE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4108
Practice Address - Country:US
Practice Address - Phone:314-276-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist