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General NPI Number Information
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NPI Number | 1366978231
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Entity Type | Individual
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Provider Name | CARRIE HARMON
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 209 S KINGSHIGHWAY ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-1693
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Country | US
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Telephone | 636-949-4302
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Fax |
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Provider Business Mailing Address
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Address Line | 54 BEAR CLAW CT
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City | WENTZVILLE
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State | MO
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Zip | 63385-3532
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Country | US
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Telephone | 314-283-5011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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