Provider Demographics
NPI:1073058798
Name:KERR, CARRI LYNN
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:LYNN
Last Name:KERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:KALAMA
Mailing Address - State:WA
Mailing Address - Zip Code:98625-9642
Mailing Address - Country:US
Mailing Address - Phone:775-291-1711
Mailing Address - Fax:
Practice Address - Street 1:13317 NE 12TH AVE STE 115A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2731
Practice Address - Country:US
Practice Address - Phone:775-291-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60713383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist