Provider Demographics
NPI:1578126447
Name:CARMACK, HYRUM PHILIP
Entity Type:Individual
Prefix:
First Name:HYRUM
Middle Name:PHILIP
Last Name:CARMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-1927
Mailing Address - Country:US
Mailing Address - Phone:978-413-5703
Mailing Address - Fax:
Practice Address - Street 1:216 WHEELER RD
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MA
Practice Address - Zip Code:01431-1927
Practice Address - Country:US
Practice Address - Phone:978-413-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist