Healthcare Provider Details

I. General information

NPI: 1407983844
Provider Name (Legal Business Name): PATTI ANN CARMAN LMP LICENSED MASSAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23892 JEFFERSON PT RD NE
KINGSTON WA
98346
US

IV. Provider business mailing address

PO BOX 2142
POULSBO WA
98370
US

V. Phone/Fax

Practice location:
  • Phone: 360-649-7234
  • Fax: 360-297-4287
Mailing address:
  • Phone: 360-649-7234
  • Fax: 360-297-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00011665
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: