Healthcare Provider Details

I. General information

NPI: 1861897852
Provider Name (Legal Business Name): MRS. COLLEEN O'CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 GOSHEN TPKE
MIDDLETOWN NY
10941-4032
US

IV. Provider business mailing address

2277 GOSHEN TPKE
MIDDLETOWN NY
10941-4032
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax:
Mailing address:
  • Phone: 845-692-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number008250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: