MEDICARE: ALYSON 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
1	225X00000X	Occupational Therapist	OT006447	GA

General Provider Information

NPI Number	:	1992151146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSON CARROLL

Provider Business Mailing Address
First Line	:	11190 MEDLOCK BRIDGE RD
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-2578
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11190 MEDLOCK BRIDGE RD
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-2578
Country	:	US
Telephone Number	:	866-622-9271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2016
Last Update Date	:	02/12/2017

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