Active NPI
Carroll Fernstrom, OT
- Occupational Therapist
- Raleigh, NC
National Provider Identifier
1588631279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0315
- Practice address
- 926 Williamson Dr
Raleigh, NC 27608-2308 - Phone
- (919) 696-6691
- Fax
- (919) 846-6767
- NPI assigned
- Mar 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0315 | NC | Primary |
Addresses
Primary practice location
926 Williamson Dr
Raleigh, NC 27608-2308
Mailing address
926 Williamson Dr
Raleigh, NC 27608-2308
Phone (919) 696-6691
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q38337A | Other | NC | MEDICARE PTAN |
| 562132986 | Other | NC | TAX ID |
| P00021102 | Other | NC | RAILROAD |
| 1321M | Other | NC | BCBS |
| 2510811-A | Other | NC | MEDICARE PTAN |
| 7301597 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378771200000",
"number": "1588631279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "926 WILLIAMSON DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276082308",
"telephone_number": "919-696-6691",
"fax_number": "919-846-6767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "926 WILLIAMSON DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276082308",
"telephone_number": "919-696-6691",
"fax_number": "919-846-6767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNSTROM",
"first_name": "CARROLL",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-02",
"last_updated": "2013-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "0315",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "Q38337A",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "562132986",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "P00021102",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1321M",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "2510811-A",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7301597",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.