Active NPI
Carrie Lynn Deisenroth, ATC
- Athletic Trainer
- Southborough, MA
National Provider Identifier
1336292440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1072
- Practice address
- 25 Marlboro Rd
Southborough, MA 01772-1207 - Phone
- (508) 786-6144
- Fax
- (508) 786-6139
- NPI assigned
- Jan 19, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1072 | MA | Primary |
| Athletic Trainer | 2255A2300X | 67 000457 | NY |
Addresses
Primary practice location
25 Marlboro Rd
Southborough, MA 01772-1207
Mailing address
25 Marlboro Rd
Southborough, MA 01772-1207
Phone (508) 786-6144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1072 | MA | MD | Mental Health Counselor |
| 67 000457 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336292440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 MARLBORO RD",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721207",
"telephone_number": "508-786-6144",
"fax_number": "508-786-6139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 MARLBORO RD",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721207",
"telephone_number": "508-786-6144",
"fax_number": "508-786-6139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEISENROTH",
"first_name": "CARRIE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "1072",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "67 000457",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.