Provider Demographics
NPI:1710457692
Name:FORD, CAROLINE (MSOT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 ALLEN AVE APT 21
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3769
Mailing Address - Country:US
Mailing Address - Phone:804-405-7814
Mailing Address - Fax:
Practice Address - Street 1:687 HARBOR RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7698
Practice Address - Country:US
Practice Address - Phone:802-378-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0134055225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist