Individual
CARROLL FERNSTROM
Active
Individual
CARROLL FERNSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0315
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1321M
BCBS
NC
01
—
2510811-A
MEDICARE PTAN
NC
01
—
562132986
TAX ID
NC
05
—
7301597
—
NC
01
—
P00021102
RAILROAD
NC
01
—
Q38337A
MEDICARE PTAN
NC
Enumeration date
03/02/2006
Last updated
09/10/2013
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