MEDICARE: MRS. CARRIE JEAN ASHWORTH L.M.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	MA00022474	WA

General Provider Information

NPI Number	:	1366625287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE JEAN ASHWORTH L.M.P.

Provider Business Mailing Address
First Line	:	3617 NW 119TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98685-3510
Country	:	US
Telephone Number	:	360-991-3493
Fax Number	:

Provider Business Practice Location Address
First Line	:	8221 NE HAZEL DELL AVE
Second Line	:	SUITE 104
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8153
Country	:	US
Telephone Number	:	360-991-3493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	09/03/2009

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