MEDICARE: KIMBERLY CARROLL OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC008577	PA

General Provider Information

NPI Number	:	1144619347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CARROLL OTD, OTR/L

Provider Business Mailing Address
First Line	:	3628 FALMOUTH DR
Second Line	:
City	:	SOUTH PARK
State	:	PA
Zip	:	15129-9440
Country	:	US
Telephone Number	:	412-260-1750
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 OLD GILKESON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1063
Country	:	US
Telephone Number	:	412-257-4444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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