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Individual

MRS. BETHANY MARIE CARROLL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
15576 COLUMBARY CT, ROSEMOUNT, MN 55068-4608
(952) 217-3325
Mailing address
15576 COLUMBARY CT, ROSEMOUNT, MN 55068-4608
(952) 217-3325

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104313
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
104313
LICENSE
MN
01
302015
NBCOT
Enumeration date
10/12/2012
Last updated
04/29/2014
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