Provider Demographics
NPI:1689757304
Name:LOCHHEAD, CAROL (OTR)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LOCHHEAD
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 1:5676 SE SAILFISH WAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-2453
Mailing Address - Country:US
Mailing Address - Phone:772-286-4766
Mailing Address - Fax:772-286-5451
Practice Address - Street 1:5676 SE SAILFISH WAY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-2453
Practice Address - Country:US
Practice Address - Phone:772-286-4766
Practice Address - Fax:772-286-5451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9179225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9992OtherBCBS