Provider Demographics
NPI:1285821504
Name:MYATT, CARRIE T (CPE)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:T
Last Name:MYATT
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:STE 212
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2485
Mailing Address - Country:US
Mailing Address - Phone:518-782-1919
Mailing Address - Fax:518-384-1959
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:STE 212
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2485
Practice Address - Country:US
Practice Address - Phone:518-782-1919
Practice Address - Fax:518-384-1959
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00A657246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other