Provider Demographics
NPI:1053948323
Name:CARLSON, ASHLEY MARISA (ATC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARISA
Last Name:CARLSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-3005
Mailing Address - Country:US
Mailing Address - Phone:740-412-9773
Mailing Address - Fax:
Practice Address - Street 1:264 E PINE AVE
Practice Address - Street 2:
Practice Address - City:MC BEE
Practice Address - State:SC
Practice Address - Zip Code:29101-8852
Practice Address - Country:US
Practice Address - Phone:843-335-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000272082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer