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NPI Code Detail

MEDICARE: MRS. ADDIE LOIS CARROLL

MEDICARE:  MRS. ADDIE LOIS CARROLL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental TherapistAR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508340100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADDIE LOIS CARROLL
Provider Business Mailing Address
First Line : 9422 DUKE DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72204-4312
Country : US
Telephone Number : 501-227-7523
Fax Number :
Provider Business Practice Location Address
First Line : 6900 N HILLS BLVD
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72116-5423
Country : US
Telephone Number : 501-834-0217
Fax Number : 501-833-0957
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2018
Last Update Date : 09/19/2018

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Directions to “ MRS. ADDIE LOIS CARROLL ” Practice Location

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