Carlos Mikkel Wynn, OTR/L
Occupational Therapist in Lawrenceville, GA. Individual provider (NPI-1).
NPI number1124485602
StatusActive
Last updated in NPPESJan 28, 2016
Details
- NPI
- 1124485602
- Entity type
- Individual (NPI-1)
- Name
- Mr. Carlos Mikkel Wynn
- Credential
- OTR/L
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 28, 2016
- Last updated
- Jan 28, 2016
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | OT006330 | GA | Yes |
Practice location
545 Old Norcross RdSuite 100
Lawrenceville, GA 30046-3389
Phone 678-377-2833 · Fax 678-377-2882
Mailing address
1550 Cornell CtStatham, GA 30666-2046
Phone 706-817-1663
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 102 Occupational Therapist providers in Lawrenceville · All 5,967 providers in Lawrenceville
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