Healthcare Provider Details

I. General information

NPI: 1982839429
Provider Name (Legal Business Name): CARRIE OHLENDORF LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W PERRY ST
PITTSFIELD IL
62363-1109
US

IV. Provider business mailing address

127 W MISSISSIPPI
BARRY IL
62312-2428
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-4122
  • Fax: 217-285-5157
Mailing address:
  • Phone: 217-617-7696
  • Fax: 217-285-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2009012048
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.007838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: