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General NPI Number Information
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NPI Number | 1730761925
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Entity Type | Individual
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Provider Name | CAROLINE GRACE CRILLY MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 11940 CAROLINA PLACE PKWY STE 200
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City | PINEVILLE
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State | NC
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Zip | 28134-7471
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Country | US
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Telephone | 704-541-9080
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Fax |
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Provider Business Mailing Address
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Address Line | 8 GROVE ST
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City | ROCHESTER
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State | NY
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Zip | 14605-2813
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Country | US
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Telephone | 585-764-2198
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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 | 17132
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 025604
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License Number State | NY
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