Individual provider Active NPI

Carla Louise Douglas, OTRL

  • Occupational Therapist
  • O'Fallon, MO
National Provider Identifier
1194867754
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
2001033078 Issued in MO
Practice address
20 Fawn Oaks Dr
O Fallon, MO 63366-1071
Phone
(314) 452-4947
Fax
(636) 379-9655
NPI assigned
Feb 12, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 2001033078 MO Primary

Addresses

Primary practice location

20 Fawn Oaks Dr
O Fallon, MO 63366-1071

Mailing address

20 Fawn Oaks Dr
O Fallon, MO 63366-1071
Phone (314) 452-4947

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2001033078MOMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194867754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 FAWN OAKS DR",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633661071",
            "telephone_number": "314-452-4947",
            "fax_number": "636-379-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 FAWN OAKS DR",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633661071",
            "telephone_number": "314-452-4947",
            "fax_number": "636-379-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "CARLA",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "OTRL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2001033078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.