Provider Demographics
NPI:1003049305
Name:CARTER, NATALIA MARIA (LMP)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:MARIA
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0191
Mailing Address - Country:US
Mailing Address - Phone:360-297-0037
Mailing Address - Fax:360-297-0420
Practice Address - Street 1:8202 NE STATE HIGHWAY 104
Practice Address - Street 2:SUITE 105
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9454
Practice Address - Country:US
Practice Address - Phone:360-297-0037
Practice Address - Fax:360-297-0420
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023132225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist