Provider Demographics
NPI:1992853782
Name:FAIRCHILD, CAROL (PTA, ATC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATC
Mailing Address - Street 1:1811 WHISPERING TRL
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-9539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-9458
Practice Address - Country:US
Practice Address - Phone:859-824-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03092225200000X
KY0895025322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer