Provider Demographics
NPI:1346808391
Name:CARROLL, ERIN MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:CARROLL
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 1:5 WHITE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3049
Mailing Address - Country:US
Mailing Address - Phone:603-702-3078
Mailing Address - Fax:
Practice Address - Street 1:100 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4402
Practice Address - Country:US
Practice Address - Phone:309-438-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer