Provider Demographics
NPI:1417987876
Name:HEAD, CAROL ELAINE (OT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELAINE
Last Name:HEAD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E MAIN ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7333
Mailing Address - Country:US
Mailing Address - Phone:302-709-0440
Mailing Address - Fax:302-709-0443
Practice Address - Street 1:280 E MAIN ST
Practice Address - Street 2:SUITE 132
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7333
Practice Address - Country:US
Practice Address - Phone:302-709-0440
Practice Address - Fax:302-709-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0000531225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000920567Medicaid
DE014365S65Medicare PIN