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General NPI Number Information
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NPI Number | 1720144777
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Entity Type | Individual
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Provider Name | NICOLETTE CARTER LMP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 706 MARKET ST
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City | TACOMA
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State | WA
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Zip | 98402-3712
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Country | US
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Telephone | 253-223-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 18524 9TH ST E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-6401
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Country | US
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Telephone | 253-223-3138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00013188
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License Number State | WA
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