Provider Demographics
NPI:1467465187
Name:CARROLL, LINDA (OTR/L,CHT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 OSUNA RD NE STE 3C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2070
Mailing Address - Country:US
Mailing Address - Phone:505-248-1586
Mailing Address - Fax:505-248-1722
Practice Address - Street 1:5850 EUBANK BLVD NE
Practice Address - Street 2:SUITE B-49/158
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-248-1586
Practice Address - Fax:505-248-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
900521253Medicare PIN
349600402Medicare PIN