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General NPI Number Information
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NPI Number | 1508815572
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Entity Type | Individual
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Provider Name | TODD MATTHEW CARSON OTR/L
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 220 N MAIN ST SUITE 2
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City | CHIEFLAND
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State | FL
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Zip | 32626-0869
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Country | US
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Telephone | 352-490-7500
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Fax | 352-490-7500
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Provider Business Mailing Address
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Address Line | PO BOX 1259
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City | OLD TOWN
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State | FL
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Zip | 32680-1259
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Country | US
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Telephone | 352-542-2477
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Fax | 352-490-7500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | FL1938
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License Number State | FL
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