Provider Demographics
NPI:1891826301
Name:GEORGE, CAROL (ATC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:G
Other - Last Name:MUDD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:317 TOWNE DR
Mailing Address - Street 2:#4
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7457
Mailing Address - Country:US
Mailing Address - Phone:270-234-0393
Mailing Address - Fax:
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:270-763-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT6562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer