MEDICARE: MS. BRIDGET KATRICIA CARVER 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	MT4446	ME

General Provider Information

NPI Number	:	1700159530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGET KATRICIA CARVER LMT

Provider Business Mailing Address
First Line	:	186 BRIDGE STREET
Second Line	:	APT. B
City	:	WESTBROOK
State	:	ME
Zip	:	04092-2933
Country	:	US
Telephone Number	:	207-735-7995
Fax Number	:

Provider Business Practice Location Address
First Line	:	583 FOREST AVE.
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-1547
Country	:	US
Telephone Number	:	207-735-7995
Fax Number	:

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

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/09/2012

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