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General NPI Number Information
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NPI Number | 1811151475
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Entity Type | Individual
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Provider Name | DANA BLAIR CARROLL MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 3216 MEADOWBROOK LN
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5440
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Country | US
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Telephone | 757-651-1137
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Fax | 757-606-2520
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Provider Business Mailing Address
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Address Line | 3216 MEADOWBROOK LN
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5440
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Country | US
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Telephone | 757-651-1137
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Fax | 757-606-2520
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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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 | 0119002296
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License Number State | VA
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