Provider Demographics
NPI:1437359700
Name:FONTE, CARLOS A (ORTL)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:FONTE
Suffix:
Gender:M
Credentials:ORTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MILLPORT CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5564
Mailing Address - Country:US
Mailing Address - Phone:864-329-1480
Mailing Address - Fax:864-329-8427
Practice Address - Street 1:126 MILLPORT CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5564
Practice Address - Country:US
Practice Address - Phone:864-329-1480
Practice Address - Fax:864-329-8427
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3242OtherSTATE LICENSE