Provider Demographics
NPI:1942584412
Name:CARLSON, NANCY ANN (PHD OTR/L)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PHD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 N LEISURE WORLD BLVD APT 604
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-7602
Mailing Address - Country:US
Mailing Address - Phone:717-877-3107
Mailing Address - Fax:
Practice Address - Street 1:3210 N LEISURE WORLD BLVD APT 604
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-7602
Practice Address - Country:US
Practice Address - Phone:717-877-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAA478339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist