Individual
CARLY NASSEREH ETTEFAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOT, OTR/L
Contact information
Practice address
3803B COMPUTER DR STE 200, RALEIGH, NC 27609-6503
(401) 835-3265
Mailing address
3803B COMPUTER DR STE 200, RALEIGH, NC 27609-6503
(401) 835-3265
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0119006980
VA
225X00000X
Occupational Therapist
Primary
13261
NC
Other
Enumeration date
03/23/2018
Last updated
08/09/2024
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