Healthcare Provider Details

I. General information

NPI: 1689757304
Provider Name (Legal Business Name): CAROL LOCHHEAD O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 SE SAILFISH WAY
STUART FL
34997-2453
US

IV. Provider business mailing address

5676 SE SAILFISH WAY
STUART FL
34997-2453
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-4766
  • Fax: 772-286-5451
Mailing address:
  • Phone: 772-286-4766
  • Fax: 772-286-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 9179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: