Healthcare Provider Details

I. General information

NPI: 1295562916
Provider Name (Legal Business Name): ALLIE FARMER MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 QUILLEN AVE
FOUNTAIN INN SC
29644-9447
US

IV. Provider business mailing address

368 TEMPLETON DR
SPARTANBURG SC
29306-6915
US

V. Phone/Fax

Practice location:
  • Phone: 864-452-1800
  • Fax:
Mailing address:
  • Phone: 864-494-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: