Individual
WANDA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, LMT, CNA
Contact information
Practice address
839 COTTONWOOD DR, SEVERNA PARK, MD 21146-2836
(443) 986-2959
Mailing address
839 COTTONWOOD DR, SEVERNA PARK, MD 21146-2836
(443) 986-2959
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
M00487
MD
225200000X
Physical Therapy Assistant
Primary
A3443
MD
225700000X
Massage Therapist
M00487
MD
374U00000X
Home Health Aide
A00010416
MD
376K00000X
Nurse's Aide
A00010416
MD
Other
Enumeration date
04/13/2007
Last updated
06/09/2015
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