MEDICARE: TIFFANY BROOKE CARTER

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	2016044537	MO

General Provider Information

NPI Number	:	1982214516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY BROOKE CARTER

Provider Business Mailing Address
First Line	:	7507 E 108TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64134-2819
Country	:	US
Telephone Number	:	816-868-5919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 WALNUT ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1315
Country	:	US
Telephone Number	:	816-216-8778
Fax Number	:	816-817-0818

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

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	08/07/2020

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