MEDICARE: MORIAH CARROLL

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	63020412	NY

General Provider Information

NPI Number	:	1871048447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORIAH CARROLL

Provider Business Mailing Address
First Line	:	7 E 14TH ST APT 18N
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 E 14TH ST APT 18N
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3127
Country	:	US
Telephone Number	:	917-363-5604
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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Directions to “ MORIAH CARROLL ” Practice Location

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