Provider Demographics
NPI:1659844082
Name:CARPENTER, KATIE ELIZABETH (ATC)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:CARPENTER
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 1:43 LINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2838
Mailing Address - Country:US
Mailing Address - Phone:802-282-3414
Mailing Address - Fax:
Practice Address - Street 1:200 UNICORN PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3342
Practice Address - Country:US
Practice Address - Phone:781-782-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA01969207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty