Provider Demographics
NPI:1972673580
Name:MITCHELL, CARRIE (OT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 LEDGE STREET
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-966-1071
Mailing Address - Fax:
Practice Address - Street 1:141 LEDGE STREET
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-966-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1597225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH272746OtherCIGNA
NH626514OtherHARVARD PILGRIM
NH761242OtherTUFTS
NH99560056Medicaid
NH13Y010015NH01OtherBCBS
NH561822OtherAETNA
NH020377315OtherCOMM TAX ID