Provider Demographics
NPI:1548601271
Name:CARROLL, CYNTHIA PAGE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:PAGE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CANYON RIM CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-3509
Mailing Address - Country:US
Mailing Address - Phone:970-261-1892
Mailing Address - Fax:
Practice Address - Street 1:950 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3451
Practice Address - Country:US
Practice Address - Phone:970-244-5522
Practice Address - Fax:970-255-7445
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1695225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics