Provider Demographics
NPI:1477266807
Name:CARELOCK, JUDY R
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:R
Last Name:CARELOCK
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 1:990 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-5008
Mailing Address - Country:US
Mailing Address - Phone:352-569-1288
Mailing Address - Fax:
Practice Address - Street 1:990 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5008
Practice Address - Country:US
Practice Address - Phone:352-569-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management