Provider Demographics
NPI:1679805006
Name:HALSTEAD, CAROLE ROBERTSON (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:ROBERTSON
Last Name:HALSTEAD
Suffix:
Gender:F
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 1:11346 OTTER RUN DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7546
Mailing Address - Country:US
Mailing Address - Phone:804-798-4094
Mailing Address - Fax:
Practice Address - Street 1:11346 OTTER RUN DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7546
Practice Address - Country:US
Practice Address - Phone:804-798-4094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist