Healthcare Provider Details

I. General information

NPI: 1619891918
Provider Name (Legal Business Name): CAROLINE GRACE WARNER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 VISTA RD
FORT MILL SC
29708-7800
US

IV. Provider business mailing address

120 HOLLIS RD APT 403
CHARLOTTE NC
28209-2518
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-4747
  • Fax:
Mailing address:
  • Phone: 304-757-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7894
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18642
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: