Provider Demographics
NPI:1457842593
Name:CARROLL, KATIE
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WRIGHTS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM STATION
Mailing Address - State:NY
Mailing Address - Zip Code:12861
Mailing Address - Country:US
Mailing Address - Phone:518-586-4944
Mailing Address - Fax:
Practice Address - Street 1:95 WRIGHTS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:PUTNAM STATION
Practice Address - State:NY
Practice Address - Zip Code:12861
Practice Address - Country:US
Practice Address - Phone:518-586-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
NY113384954343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)