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Individual

MRS. CARRIE LYNN DEISENROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
25 MARLBORO RD, SOUTHBOROUGH, MA 01772-1207
(508) 786-6144
(508) 786-6139
Mailing address
25 MARLBORO RD, SOUTHBOROUGH, MA 01772-1207
(508) 786-6144
(508) 786-6139

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1072
MA
2255A2300X
Athletic Trainer
67 000457
NY

Other

Enumeration date
01/19/2007
Last updated
07/08/2007
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