Provider Demographics
NPI:1679320816
Name:CARROLL, JOANNE L (OT/L, MED)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:OT/L, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1407
Mailing Address - Country:US
Mailing Address - Phone:201-264-3266
Mailing Address - Fax:
Practice Address - Street 1:16 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1407
Practice Address - Country:US
Practice Address - Phone:201-264-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00308700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist