Provider Demographics
NPI:1366790685
Name:PICKENS, CARLYNN RENEE CORLEY (MS OTR/L)
Entity type:Individual
Prefix:
First Name:CARLYNN
Middle Name:RENEE CORLEY
Last Name:PICKENS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1523 FLOURNOY CIR W APT 10210
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-1434
Mailing Address - Country:US
Mailing Address - Phone:704-340-3481
Mailing Address - Fax:
Practice Address - Street 1:1523 FLOURNOY CIR W APT 10210
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-1434
Practice Address - Country:US
Practice Address - Phone:706-340-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003584225X00000X, 225XP0200X
FLOT22187225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics