Provider Demographics
NPI:1508154741
Name:STAFFORD, CAROLYN CLAIRE ADAMS (MOTR)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:CLAIRE ADAMS
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:CLAIRE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR
Mailing Address - Street 1:738 ROTHMER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5534
Mailing Address - Country:US
Mailing Address - Phone:225-276-8199
Mailing Address - Fax:
Practice Address - Street 1:738 ROTHMER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-5534
Practice Address - Country:US
Practice Address - Phone:225-276-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200425225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist