Provider Demographics
NPI:1316122062
Name:PTACIN, CARRIE LEE (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LEE
Last Name:PTACIN
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 1:7990 E SNYDER RD APT 11101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9022
Mailing Address - Country:US
Mailing Address - Phone:520-904-7812
Mailing Address - Fax:
Practice Address - Street 1:7990 E SNYDER RD APT 11101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-9022
Practice Address - Country:US
Practice Address - Phone:520-904-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3146225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation