Provider Demographics
NPI:1952518359
Name:SOLANO, CAROLYNN SHANIQUE (MSOT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYNN
Middle Name:SHANIQUE
Last Name:SOLANO
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9597 INDIAN BEECH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3573
Mailing Address - Country:US
Mailing Address - Phone:973-896-4332
Mailing Address - Fax:
Practice Address - Street 1:9597 INDIAN BEECH AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3573
Practice Address - Country:US
Practice Address - Phone:973-896-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7113225X00000X
NC222Q00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302158Medicaid