Provider Demographics
NPI:1376794990
Name:CARROLL, MICHELLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ABBEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4604
Mailing Address - Country:US
Mailing Address - Phone:171-739-7426
Mailing Address - Fax:171-739-7142
Practice Address - Street 1:100 ABBEYVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4604
Practice Address - Country:US
Practice Address - Phone:171-739-7426
Practice Address - Fax:171-739-7142
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009151225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist