Provider Demographics
NPI:1235654724
Name:CARSTEN, AMANDA BETH (ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:CARSTEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OCHRE POINT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-4149
Mailing Address - Country:US
Mailing Address - Phone:401-341-2458
Mailing Address - Fax:401-341-2911
Practice Address - Street 1:100 OCHRE POINT AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-4149
Practice Address - Country:US
Practice Address - Phone:401-341-2458
Practice Address - Fax:401-341-2911
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA