Provider Demographics
NPI:1528202793
Name:RIDEOUT, CAROLE ELAINE (DSP)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:ELAINE
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BIRMINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-1190
Mailing Address - Country:US
Mailing Address - Phone:207-582-2440
Mailing Address - Fax:
Practice Address - Street 1:222 BIRMINGHAM RD
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:ME
Practice Address - Zip Code:04330-1190
Practice Address - Country:US
Practice Address - Phone:207-582-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging