MEDICARE: MRS. CHARA MARIE CARNEY-HANSON 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	MA00019123	WA

General Provider Information

NPI Number	:	1922202365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARA MARIE CARNEY-HANSON LMP

Provider Business Mailing Address
First Line	:	713 E ORANGE AVE
Second Line	:
City	:	BURLINGTON
State	:	WA
Zip	:	98233-2315
Country	:	US
Telephone Number	:	360-755-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 RIVERSIDE DR
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-5406
Country	:	US
Telephone Number	:	360-428-5055
Fax Number	:

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. CHARA MARIE CARNEY-HANSON LMP” Practice Location

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