Provider Demographics
NPI:1457501017
Name:BROLLIER, CARRIE
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:BROLLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BAKER ST
Mailing Address - Street 2:APT 3
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1909
Mailing Address - Country:US
Mailing Address - Phone:781-821-3499
Mailing Address - Fax:
Practice Address - Street 1:31 BAKER STREET
Practice Address - Street 2:APT 3
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1909
Practice Address - Country:US
Practice Address - Phone:781-821-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist