MEDICARE: CAROLINE WILLIARD LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2026010573	MO

General Provider Information

NPI Number	:	1225984446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE WILLIARD LMT

Provider Business Mailing Address
First Line	:	1324 FOREST CREEK DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63303-5811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 FOREST CREEK DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63303-5811
Country	:	US
Telephone Number	:	913-205-7021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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