Provider Demographics
NPI:1083026637
Name:CABOT, CARLENE
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:CABOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 S WILLIAMSON BLVD
Mailing Address - Street 2:SUITE 774
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-8311
Mailing Address - Country:US
Mailing Address - Phone:800-330-7711
Mailing Address - Fax:386-944-7202
Practice Address - Street 1:5535 S WILLIAMSON BLVD
Practice Address - Street 2:SUITE 774
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8311
Practice Address - Country:US
Practice Address - Phone:800-330-7711
Practice Address - Fax:386-944-7202
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02099224Z00000X
PAOP007184224Z00000X
IDOTA1298224Z00000X
NJ46TA09101800224Z00000X
WAOC60452792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant