Provider Demographics
NPI:1063960557
Name:ROSS, CAROLYN (OTR/L)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KOLE
Other - Middle Name:
Other - Last Name:CAROLYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2510 N PINES RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-7636
Mailing Address - Country:US
Mailing Address - Phone:509-315-5711
Mailing Address - Fax:509-443-4170
Practice Address - Street 1:2510 N PINES RD STE 3
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-315-5711
Practice Address - Fax:509-443-4170
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA6835225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist