=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447574181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGINIA MARIE CARTER LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2010
-----------------------------------------------------
Last Update Date | 03/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 CHURCH ST
-----------------------------------------------------
City | SWANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43558-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-826-9146
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4078 COUNTY ROAD V
-----------------------------------------------------
City | LIBERTY CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43532-9507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-360-2288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 16603
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------