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General NPI Number Information
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NPI Number | 1710457692
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Entity Type | Individual
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Provider Name | CAROLINE FORD MSOT
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Gender | Female
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 687 HARBOR RD
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City | SHELBURNE
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State | VT
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Zip | 05482-7698
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Country | US
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Telephone | 802-378-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 459 ALLEN AVE APT 21
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City | PORTLAND
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State | ME
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Zip | 04103-3769
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Country | US
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Telephone | 804-405-7814
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Fax |
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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 | 072.0134055
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License Number State | VT
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