Provider Demographics
NPI:1487343414
Name:HARTMAN, CARLY ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11151 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1817
Mailing Address - Country:US
Mailing Address - Phone:513-245-0253
Mailing Address - Fax:
Practice Address - Street 1:11151 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-1817
Practice Address - Country:US
Practice Address - Phone:513-245-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009278225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0049071Medicaid