Provider Demographics
NPI:1316420276
Name:CARVER, KATHRYN RENEE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RENEE
Last Name:CARVER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:WRENS
Mailing Address - State:GA
Mailing Address - Zip Code:30833-1053
Mailing Address - Country:US
Mailing Address - Phone:706-207-1795
Mailing Address - Fax:
Practice Address - Street 1:102 SALUDA POINTE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7295
Practice Address - Country:US
Practice Address - Phone:706-207-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCATR.1965ATH2255A2300X
20000388682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer