Provider Demographics
NPI:1235939497
Name:CARTER, CAMRYN JADE (COTA/L)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:JADE
Last Name:CARTER
Suffix:
Gender:
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 S KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2667
Mailing Address - Country:US
Mailing Address - Phone:479-747-3738
Mailing Address - Fax:
Practice Address - Street 1:1607 S KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2667
Practice Address - Country:US
Practice Address - Phone:479-747-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A2103224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant