Provider Demographics
NPI:1508815572
Name:CARSON, TODD MATTHEW (OTR/L)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MATTHEW
Last Name:CARSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-1259
Mailing Address - Country:US
Mailing Address - Phone:352-542-2477
Mailing Address - Fax:352-490-7500
Practice Address - Street 1:220 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0869
Practice Address - Country:US
Practice Address - Phone:352-490-7500
Practice Address - Fax:352-490-7500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2658AMedicare ID - Type UnspecifiedMEDICARE INDIV PROVIDER