Provider Demographics
NPI:1073632691
Name:SEASE, CAROLE A (MSOTRL)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:SEASE
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4015
Mailing Address - Country:US
Mailing Address - Phone:540-772-1622
Mailing Address - Fax:
Practice Address - Street 1:1127 PERSINGER RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3829
Practice Address - Country:US
Practice Address - Phone:540-343-1691
Practice Address - Fax:540-343-1696
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0119001503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist