Provider Demographics
NPI:1659924421
Name:FERENCHAK, CAROL LYNN (MSOT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:FERENCHAK
Suffix:
Gender:
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MDG/RAF LAKENHEATH
Mailing Address - Street 2:UNIT 5115
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 MDG/RAF LAKENHEATH
Practice Address - Street 2:UNIT 5115
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461
Practice Address - Country:GB
Practice Address - Phone:831-422-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15258225X00000X
DEU1-0012408225X00000X
MD09991225X00000X
225X00000X
SC6529225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist