=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659502169
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARISSA M KAMARAINEN LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2009
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 MAIN ST SW
-----------------------------------------------------
City | RONAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59864-2705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-676-0170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38038 MINK LN
-----------------------------------------------------
City | RONAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59864-8882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-382-0460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA60090425
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | LMT-LMT-LIC-4120
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | LMT-LMT-LIC-4120
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------