Provider Demographics
NPI:1265925044
Name:STEVENS, CAROLINE MARIE (ATC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARIE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:MARIE
Other - Last Name:LIGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:715 S GRINNELL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1685
Mailing Address - Country:US
Mailing Address - Phone:517-812-4551
Mailing Address - Fax:
Practice Address - Street 1:715 S GRINNELL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1685
Practice Address - Country:US
Practice Address - Phone:517-812-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer