Provider Demographics
NPI:1568923779
Name:MACDONALD, CAREY L (ATC, EDD)
Entity Type:Individual
Prefix:MS
First Name:CAREY
Middle Name:L
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:ATC, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56A PICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-6761
Mailing Address - Country:US
Mailing Address - Phone:978-314-5951
Mailing Address - Fax:
Practice Address - Street 1:352 LAFAYETTE ST
Practice Address - Street 2:SALEM STATE UNIVERSITY
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-0197
Practice Address - Country:US
Practice Address - Phone:978-542-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer