Provider Demographics
NPI:1609060979
Name:CAROL'S SPECIALTY SHOPPE
Entity Type:Organization
Organization Name:CAROL'S SPECIALTY SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:NEARING
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-273-5055
Mailing Address - Street 1:809 E EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7928
Mailing Address - Country:US
Mailing Address - Phone:717-273-5055
Mailing Address - Fax:
Practice Address - Street 1:809 E EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7928
Practice Address - Country:US
Practice Address - Phone:717-273-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier