Provider Demographics
NPI:1366170672
Name:CARPENTER, ERIC (ATS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 STATE ROUTE 67
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9128
Mailing Address - Country:US
Mailing Address - Phone:419-303-0909
Mailing Address - Fax:
Practice Address - Street 1:1216 SUNBURY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2086
Practice Address - Country:US
Practice Address - Phone:614-251-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program