MEDICARE: CAROLYN STEVENS LMT, BSC

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	6789138-4701	UT
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1760724181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN STEVENS LMT, BSC

Provider Business Mailing Address
First Line	:	1961 E REDONDO AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3119
Country	:	US
Telephone Number	:	435-655-1703
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 E REDONDO AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3119
Country	:	US
Telephone Number	:	435-655-1703
Fax Number	:

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

Provider Enumeration Date	:	03/24/2013
Last Update Date	:	03/22/2024

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