Provider Demographics
NPI:1700102548
Name:ALSTON, CARRIE HOLLAND (OTR)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:HOLLAND
Last Name:ALSTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:491 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4869
Mailing Address - Country:US
Mailing Address - Phone:434-971-8889
Mailing Address - Fax:
Practice Address - Street 1:491 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4869
Practice Address - Country:US
Practice Address - Phone:434-971-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist