Individual
MR. LEWIS GLENN CARVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
614 AZALEA ST SE, DEMOTTE, IN 46310-8744
(219) 987-2894
Mailing address
614 AZALEA ST SE, DEMOTTE, IN 46310-8744
(219) 987-2894
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001364A
IN
Other
Enumeration date
05/01/2008
Last updated
05/01/2008
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