Provider Demographics
NPI:1316178254
Name:DECARLO, CRAIG J
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:DECARLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 KIAWAH LOOP
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-3902
Mailing Address - Country:US
Mailing Address - Phone:919-920-1943
Mailing Address - Fax:
Practice Address - Street 1:380 COUNTRY DAY RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8857
Practice Address - Country:US
Practice Address - Phone:919-580-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist