Provider Demographics
NPI:1598823460
Name:BOUSFIELD, CAROLYN K (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:K
Last Name:BOUSFIELD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:K
Other - Last Name:ZAYNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:50 BAKER BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3674
Mailing Address - Country:US
Mailing Address - Phone:330-865-1600
Mailing Address - Fax:
Practice Address - Street 1:1 PARK WEST BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4218
Practice Address - Country:US
Practice Address - Phone:330-564-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT2960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBO4202451Medicare PIN