Provider Demographics
NPI:1902854862
Name:ROLLER, CAROLYN L (OT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:ROLLER
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 1:2605 MOSS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4482
Mailing Address - Country:US
Mailing Address - Phone:865-719-1604
Mailing Address - Fax:
Practice Address - Street 1:2605 MOSS CREEK RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4482
Practice Address - Country:US
Practice Address - Phone:865-719-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4325119OtherBLUECROSS BLUESHIELD
TN5991431OtherCIGNA
TNP01122536OtherRAILROAD MEDICARE
TN9070481OtherAETNA
TN3656438Medicaid
TN0677340010Medicare NSC
TN5991431OtherCIGNA
TN0677340005Medicare NSC
TN3656437Medicare PIN
TN0677340003Medicare NSC
TN0677340004Medicare NSC
TN103I678202Medicare PIN