Healthcare Provider Details

I. General information

NPI: 1073632691
Provider Name (Legal Business Name): CAROLE A SEASE MSOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 PERSINGER RD SW
ROANOKE VA
24015-3829
US

IV. Provider business mailing address

3611 VIEW AVE
ROANOKE VA
24018-4015
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-1691
  • Fax: 540-343-1696
Mailing address:
  • Phone: 540-772-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberVA0119001503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: