Provider Demographics
NPI:1053177063
Name:CARROLL, MACY ANN (OTD, OTR)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:ANN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3223 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2452
Mailing Address - Country:US
Mailing Address - Phone:918-250-7093
Mailing Address - Fax:
Practice Address - Street 1:3223 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2452
Practice Address - Country:US
Practice Address - Phone:918-250-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist