Provider Demographics
NPI:1245865302
Name:MILLS, CARITA RACHELLE (ATC)
Entity type:Individual
Prefix:
First Name:CARITA
Middle Name:RACHELLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CARITA
Other - Middle Name:RACHELLE
Other - Last Name:LOGSDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:101 FORT AVE
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2600
Mailing Address - Country:US
Mailing Address - Phone:304-813-4434
Mailing Address - Fax:
Practice Address - Street 1:101 FORT AVE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2600
Practice Address - Country:US
Practice Address - Phone:304-813-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0014522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer