MEDICARE: MRS. CARRIE DENICE BROWN LMP

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	MA00013880	WA

General Provider Information

NPI Number	:	1447316252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE DENICE BROWN LMP

Provider Business Mailing Address
First Line	:	PO BOX 1370
Second Line	:
City	:	MCKENNA
State	:	WA
Zip	:	98558-1370
Country	:	US
Telephone Number	:	360-400-2002
Fax Number	:	360-400-2004

Provider Business Practice Location Address
First Line	:	9111 346TH ST S
Second Line	:	SUITE 3
City	:	ROY
State	:	WA
Zip	:	98580
Country	:	US
Telephone Number	:	360-400-2002
Fax Number	:	360-400-2004

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. CARRIE DENICE BROWN LMP” Practice Location

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