Provider Demographics
NPI:1386170546
Name:LITTLE, CARLIE
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:
Other - Last Name:MATYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3913 LELAND AVE NW
Mailing Address - Street 2:PO BOX 25
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-5027
Mailing Address - Country:US
Mailing Address - Phone:210-454-5606
Mailing Address - Fax:
Practice Address - Street 1:3913 LELAND AVE. NW
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321
Practice Address - Country:US
Practice Address - Phone:210-454-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner