MEDICARE: MR. TREVOR FARENTINO CARTER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0198	AR

General Provider Information

NPI Number	:	1306811542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TREVOR FARENTINO CARTER ATC

Provider Business Mailing Address
First Line	:	155 ROB ST
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-3054
Country	:	US
Telephone Number	:	479-530-4417
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 ROB ST
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-3054
Country	:	US
Telephone Number	:	479-530-4417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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