Provider Demographics
NPI:1023393675
Name:CAROLAND, JAMIE KIM (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:KIM
Last Name:CAROLAND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 DEL CURTO RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4826
Mailing Address - Country:US
Mailing Address - Phone:512-442-6268
Mailing Address - Fax:
Practice Address - Street 1:2708 DEL CURTO RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4826
Practice Address - Country:US
Practice Address - Phone:512-442-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT004671225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist