Active NPI
Lan Carrico, MA, OTR/L
- Occupational Therapist
- San Dimas, CA
National Provider Identifier
1669849428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 11906
- Practice address
- 1301 W Arrow Hwy
Suite 130
San Dimas, CA 91773-2330 - Phone
- (909) 222-2745
- Fax
- (909) 929-0805
- NPI assigned
- Aug 27, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 11906 | CA | Primary |
Addresses
Primary practice location
1301 W Arrow Hwy
Suite 130
San Dimas, CA 91773-2330
Mailing address
1301 W Arrow Hwy
Suite 130
San Dimas, CA 91773-2330
Phone (909) 222-2745
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11906 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carrico Pediatric Therapy, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- San Dimas, CA
- NPI 1851754428
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460851200000",
"number": "1669849428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 W ARROW HWY",
"address_2": "SUITE 130",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917732330",
"telephone_number": "909-222-2745",
"fax_number": "909-929-0805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 W ARROW HWY",
"address_2": "SUITE 130",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917732330",
"telephone_number": "909-222-2745",
"fax_number": "909-929-0805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRICO",
"first_name": "LAN",
"credential": "MA, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-27",
"last_updated": "2016-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "11906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Dimas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.