Individual
HEATHER CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
430 E CLEVELAND RD, GRANGER, IN 46530-5624
(574) 271-3305
Mailing address
19839 DICE ST, SOUTH BEND, IN 46614-5513
(574) 217-2213
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32001597A
COTA
IN
Enumeration date
08/21/2014
Last updated
08/21/2014
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