Provider Demographics
NPI:1124293766
Name:FORD, CAROLYN M (OT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2654
Mailing Address - Country:US
Mailing Address - Phone:540-213-1201
Mailing Address - Fax:540-213-1204
Practice Address - Street 1:1 GREEN HILL DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2654
Practice Address - Country:US
Practice Address - Phone:540-213-1201
Practice Address - Fax:540-213-1204
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA346238OtherANTHEM