Provider Demographics
NPI:1215058060
Name:COCKRELL, CARLA SALZMEN (OTR)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:SALZMEN
Last Name:COCKRELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 E 109TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1202
Mailing Address - Country:US
Mailing Address - Phone:317-697-2872
Mailing Address - Fax:317-844-9742
Practice Address - Street 1:1605 E 109TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1202
Practice Address - Country:US
Practice Address - Phone:317-697-2872
Practice Address - Fax:317-844-9742
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002553A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist