Provider Demographics
NPI:1902928625
Name:GANT, CAROL (OTR)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GANT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21391 RIDGEDALE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2707
Mailing Address - Country:US
Mailing Address - Phone:248-336-3969
Mailing Address - Fax:
Practice Address - Street 1:21391 RIDGEDALE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2707
Practice Address - Country:US
Practice Address - Phone:248-336-3969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist