=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699387126
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITNEY ANN CARREON LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2020
-----------------------------------------------------
Last Update Date | 08/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1397 NW 6TH ST BLDG 19A
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97756-1433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-279-0733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3253 SW NEWBERRY AVE
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97756-8952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-279-0733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 20778
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------