Provider Demographics
NPI:1275942898
Name:KERR, CARRIE (ATC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:DITZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1438
Mailing Address - Country:US
Mailing Address - Phone:410-810-7495
Mailing Address - Fax:410-556-6917
Practice Address - Street 1:300 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1438
Practice Address - Country:US
Practice Address - Phone:410-810-7495
Practice Address - Fax:410-556-6917
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA001652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer