Provider Demographics
NPI:1609505841
Name:FUMAROLA, CARISSA (ATC)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:FUMAROLA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9604 DEER TRACK RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7046
Mailing Address - Country:US
Mailing Address - Phone:812-221-5399
Mailing Address - Fax:
Practice Address - Street 1:11123 MONTGOMERY RD STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2390
Practice Address - Country:US
Practice Address - Phone:513-469-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000051258OtherBOCATC