Individual
LISA ANNE CAROLLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,OTL
Contact information
Practice address
1523 US HIGHWAY 2, CRYSTAL FALLS, MI 49920-9633
(906) 874-1444
Mailing address
506 W B ST, IRON MOUNTAIN, MI 49801-2722
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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