Provider Demographics
NPI:1013082064
Name:WALL, CAROL YVONNE (OTR, CEAS)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:YVONNE
Last Name:WALL
Suffix:
Gender:F
Credentials:OTR, CEAS
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:YVONNE
Other - Last Name:FULMER(MAIDEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15906 DUCKWEED CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8895
Mailing Address - Country:US
Mailing Address - Phone:303-250-8778
Mailing Address - Fax:
Practice Address - Street 1:3451 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5073
Practice Address - Country:US
Practice Address - Phone:303-680-6121
Practice Address - Fax:303-680-8627
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist