Provider Demographics
NPI:1003311838
Name:CARNEVALE, MARLEE JEANETTE (LAT,ATC)
Entity Type:Individual
Prefix:
First Name:MARLEE
Middle Name:JEANETTE
Last Name:CARNEVALE
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 LYNTON CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8041
Mailing Address - Country:US
Mailing Address - Phone:561-779-7290
Mailing Address - Fax:
Practice Address - Street 1:1825 LYNTON CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8041
Practice Address - Country:US
Practice Address - Phone:561-779-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-25
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer