Healthcare Provider Details

I. General information

NPI: 1508815572
Provider Name (Legal Business Name): TODD MATTHEW CARSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MAIN ST SUITE 2
CHIEFLAND FL
32626-0869
US

IV. Provider business mailing address

PO BOX 1259
OLD TOWN FL
32680-1259
US

V. Phone/Fax

Practice location:
  • Phone: 352-490-7500
  • Fax: 352-490-7500
Mailing address:
  • Phone: 352-542-2477
  • Fax: 352-490-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberFL1938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: