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NPI Code Detail

MEDICARE: CAROL FAIRCHILD PTA, ATC

MEDICARE: CAROL FAIRCHILD PTA, 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
1225200000XPhysical Therapy AssistantA03092KY
22255A2300XAthletic Trainer089502532KY

General Provider Information

NPI Number : 1992853782
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL FAIRCHILD PTA, ATC
Provider Business Mailing Address
First Line : 1811 WHISPERING TRL
Second Line :
City : UNION
State : KY
Zip : 41091-9539
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 KIMBERLY LN
Second Line :
City : WILLIAMSTOWN
State : KY
Zip : 41097-9458
Country : US
Telephone Number : 859-824-7803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 08/18/2014

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