Provider Demographics
NPI:1609964931
Name:ESTERHUIZEN, CARROL ANN (PT MHS OCS)
Entity Type:Individual
Prefix:MRS
First Name:CARROL
Middle Name:ANN
Last Name:ESTERHUIZEN
Suffix:
Gender:F
Credentials:PT MHS OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 NW ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3519
Mailing Address - Country:US
Mailing Address - Phone:541-753-4246
Mailing Address - Fax:541-757-0545
Practice Address - Street 1:2635 NW ROLLING GREEN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3519
Practice Address - Country:US
Practice Address - Phone:541-753-4246
Practice Address - Fax:541-757-0545
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R130207Medicare ID - Type Unspecified