Provider Demographics
NPI:1447983473
Name:CARPENTER, TRISTEN
Entity type:Individual
Prefix:MS
First Name:TRISTEN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6462 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-2506
Mailing Address - Country:US
Mailing Address - Phone:229-412-9984
Mailing Address - Fax:
Practice Address - Street 1:470 FELLOWSHIP HOME LN
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6008
Practice Address - Country:US
Practice Address - Phone:229-244-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist