MEDICARE: TAMMY CARRELL LAT, ATC, MS

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	AT2609	TX

General Provider Information

NPI Number	:	1942606215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY CARRELL LAT, ATC, MS

Provider Business Mailing Address
First Line	:	701 PAULS LN
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-4269
Country	:	US
Telephone Number	:	903-243-0746
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 PAULS LN
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-4269
Country	:	US
Telephone Number	:	903-243-0746
Fax Number	:

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

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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