Healthcare Provider Details

I. General information

NPI: 1225044027
Provider Name (Legal Business Name): TIANNE CAROLYN CARRIGAN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SUSSEX E. SUITE 2
TENINO WA
98589
US

IV. Provider business mailing address

PO BOX 294
TENINO WA
98589-0294
US

V. Phone/Fax

Practice location:
  • Phone: 360-264-5754
  • Fax: 806-213-3209
Mailing address:
  • Phone: 360-264-5754
  • Fax: 806-213-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00013133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: