MEDICARE: MS. AMANDA CARROLL 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	8557	NC

General Provider Information

NPI Number	:	1326388364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA CARROLL OTR/L

Provider Business Mailing Address
First Line	:	2903 N DAVIDSON ST
Second Line	:	APT. 2033
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-1096
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2903 N DAVIDSON ST
Second Line	:	APT. 2033
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-1096
Country	:	US
Telephone Number	:	910-389-6968
Fax Number	:

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

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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