Provider Demographics
NPI:1730351263
Name:LALLA, CARISA LEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CARISA
Middle Name:LEE
Last Name:LALLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CARISA
Other - Middle Name:SLOAN
Other - Last Name:LALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6191 N STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 650
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2246
Mailing Address - Country:US
Mailing Address - Phone:800-284-0429
Mailing Address - Fax:800-482-0198
Practice Address - Street 1:6121 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4803
Practice Address - Country:US
Practice Address - Phone:301-770-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist