Provider Demographics
NPI:1588890610
Name:DERDICH, CARRIE HARTMAN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:HARTMAN
Last Name:DERDICH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MEADOW SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6936
Mailing Address - Country:US
Mailing Address - Phone:724-830-8858
Mailing Address - Fax:
Practice Address - Street 1:685 ANGELA DRIVE
Practice Address - Street 2:ST ANNE HOME
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-940-3468
Practice Address - Fax:724-940-3969
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist