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General NPI Number Information
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NPI Number | 1912497165
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Entity Type | Individual
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Provider Name | HEATHER JO CARROLL
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Gender | Female
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 5021 MERCER UNIVERSITY DR STE D2
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City | MACON
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State | GA
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Zip | 31210-6228
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Country | US
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Telephone | 478-845-3520
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Fax | 478-956-0401
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Provider Business Mailing Address
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Address Line | PO BOX 1552
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City | BYRON
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State | GA
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Zip | 31008-1552
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Country | US
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Telephone |
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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 | OT004509
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License Number State | GA
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