Individual
KYLIE ELIZABETH CARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
207 W NORTH ST, MOUNT STERLING, IL 62353-1208
(217) 257-3560
Mailing address
207 W NORTH ST, MOUNT STERLING, IL 62353-1208
(217) 257-3560
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.0005484
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DFS848415199
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/14/2021
Last updated
01/14/2021
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