Provider Demographics
NPI:1750314258
Name:FAURE, CAROLINE E (EDD; ATC)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:E
Last Name:FAURE
Suffix:
Gender:F
Credentials:EDD; ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13279 N MOONGLOW LN
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5122
Mailing Address - Country:US
Mailing Address - Phone:208-237-2971
Mailing Address - Fax:
Practice Address - Street 1:13279 N MOONGLOW LN
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-5122
Practice Address - Country:US
Practice Address - Phone:208-237-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-2002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer