Provider Demographics
NPI:1043353659
Name:DUDLEY, CARRIE ANN (MS, AT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MS, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WINSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-5752
Mailing Address - Country:US
Mailing Address - Phone:609-529-6383
Mailing Address - Fax:
Practice Address - Street 1:4056 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4779
Practice Address - Country:US
Practice Address - Phone:609-588-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001293002255A2300X
PART005501246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other