Provider Demographics
NPI:1912863770
Name:E
Entity type:Organization
Organization Name:E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:402-658-1543
Mailing Address - Street 1:6203 S JONES RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-5027
Mailing Address - Country:US
Mailing Address - Phone:402-658-1543
Mailing Address - Fax:402-658-1543
Practice Address - Street 1:6203 S JONES RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-5027
Practice Address - Country:US
Practice Address - Phone:402-658-1543
Practice Address - Fax:402-658-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-24
Last Update Date:2025-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty