Provider Demographics
NPI:1881204246
Name:BAUGHMAN, CARISSA NICOLE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:NICOLE
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:NICOLE
Other - Last Name:ANDERSON/CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 S OBRIEN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2418
Mailing Address - Country:US
Mailing Address - Phone:812-569-3310
Mailing Address - Fax:
Practice Address - Street 1:2400 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5351
Practice Address - Country:US
Practice Address - Phone:800-841-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008556A225X00000X
INRBT-19-95273106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician