Provider Demographics
NPI:1174572812
Name:O'CARROLL, SUSAN MARIE (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:O'CARROLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 APPLETON WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7341
Mailing Address - Country:US
Mailing Address - Phone:910-793-0592
Mailing Address - Fax:
Practice Address - Street 1:5725 OLEANDER DR
Practice Address - Street 2:SUITE B6
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4724
Practice Address - Country:US
Practice Address - Phone:910-799-7009
Practice Address - Fax:910-799-7029
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE0007OtherMEDCOST
NC079F6OtherBLUE CROSS BLUE SHIELD
NC079F6OtherBLUE CROSS BLUE SHIELD