Provider Demographics
NPI:1568050953
Name:MCDIFFITT, CAROLYN SUE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:MCDIFFITT
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 1:121 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29805-8818
Mailing Address - Country:US
Mailing Address - Phone:803-292-0970
Mailing Address - Fax:
Practice Address - Street 1:121 MORRIS RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29805-8818
Practice Address - Country:US
Practice Address - Phone:803-292-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer