Provider Demographics
NPI:1942631221
Name:LOVE, CAROLINE MULLIS (COTA/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MULLIS
Last Name:LOVE
Suffix:
Gender:F
Credentials:COTA/L, CLT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3700 TAYLOR GLEN LN NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3400
Mailing Address - Country:US
Mailing Address - Phone:704-721-0478
Mailing Address - Fax:704-721-0479
Practice Address - Street 1:3700 TAYLOR GLEN LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3400
Practice Address - Country:US
Practice Address - Phone:704-721-0478
Practice Address - Fax:704-721-0479
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6570224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant