Provider Demographics
NPI:1427007749
Name:STODDARD, CARLA E (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:E
Last Name:STODDARD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9485
Mailing Address - Country:US
Mailing Address - Phone:919-831-9084
Mailing Address - Fax:
Practice Address - Street 1:704A COLLEGE ST NE
Practice Address - Street 2:BARTON COLLEGE
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3104
Practice Address - Country:US
Practice Address - Phone:252-399-6377
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist