MEDICARE: MS. CARRIE ANN HIMES M.ED, 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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1194718817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE ANN HIMES M.ED, ATC

Provider Business Mailing Address
First Line	:	836 LINCOLN DR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-6908
Country	:	US
Telephone Number	:	724-612-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	24009 MONTEZUMA AVE
Second Line	:	TBS/S-3/ ATR
City	:	QUANTICO
State	:	VA
Zip	:	22134-5123
Country	:	US
Telephone Number	:	703-784-6558
Fax Number	:

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	07/08/2007

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