Provider Demographics
NPI:1447420385
Name:CARROW, RICKEY DALE (ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:RICKEY
Middle Name:DALE
Last Name:CARROW
Suffix:
Gender:M
Credentials:ORTHOTIST
Other - Prefix:MR
Other - First Name:RICKEY
Other - Middle Name:DALE
Other - Last Name:CARROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ORTHOTIST
Mailing Address - Street 1:168 JEFFERSON RD.
Mailing Address - Street 2:
Mailing Address - City:PINETOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27865-9463
Mailing Address - Country:US
Mailing Address - Phone:252-927-2088
Mailing Address - Fax:252-927-2088
Practice Address - Street 1:168 JEFFERSON RD.
Practice Address - Street 2:
Practice Address - City:PINETOWN
Practice Address - State:NC
Practice Address - Zip Code:27865-9463
Practice Address - Country:US
Practice Address - Phone:252-927-2088
Practice Address - Fax:252-927-2088
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X
DECO0036641744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist