=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790074938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARJORIE ANN KOHL-CARTER LMT, CTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2011
-----------------------------------------------------
Last Update Date | 03/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 E HIGH ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37355-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-273-2693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1731 POCAHONTAS RD
-----------------------------------------------------
City | MORRISON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37357-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-273-2693
-----------------------------------------------------
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 | 0000002257
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------