Provider Demographics
NPI:1215990882
Name:BARTELME, CARRIE ANN (MS, OTR-L)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANN
Last Name:BARTELME
Suffix:
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 1:4062 PEACHTREE RD NE STE A-123
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3021
Mailing Address - Country:US
Mailing Address - Phone:404-409-7099
Mailing Address - Fax:
Practice Address - Street 1:4062 PEACHTREE RD NE STE A-123
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3021
Practice Address - Country:US
Practice Address - Phone:404-409-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003448225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000947185CMedicaid
GA10036804OtherAMERIGROUP
GA7099600OtherAETNA