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Individual
LISA ANNE CAROLLO
Active
Individual
LISA ANNE CAROLLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,OTL
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
5201003009
MI
Other
Enumeration date
07/26/2018
Last updated
07/26/2018
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