Provider Demographics
NPI:1811151475
Name:CARROLL, DANA BLAIR (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:BLAIR
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5440
Mailing Address - Country:US
Mailing Address - Phone:757-651-1137
Mailing Address - Fax:757-606-2520
Practice Address - Street 1:3216 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5440
Practice Address - Country:US
Practice Address - Phone:757-651-1137
Practice Address - Fax:757-606-2520
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
VA0119002296225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10066936OtherOPTIMA HEALTH
VA271537264OtherTRICARE PRIME
VA271537264Medicaid