Provider Demographics
NPI:1689647901
Name:ASTILL, CAROL MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:ASTILL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4544 TULIP CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-0730
Mailing Address - Country:US
Mailing Address - Phone:901-213-4902
Mailing Address - Fax:901-797-6795
Practice Address - Street 1:1689 NONCONNAH BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2102
Practice Address - Country:US
Practice Address - Phone:901-797-6805
Practice Address - Fax:901-797-6795
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000004672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer