Provider Demographics
NPI:1093182065
Name:TANGUAY, CARLA LEE (MT-BC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LEE
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DRAGONFLY WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-6233
Mailing Address - Country:US
Mailing Address - Phone:207-812-8662
Mailing Address - Fax:
Practice Address - Street 1:12 DRAGONFLY WAY
Practice Address - Street 2:
Practice Address - City:MOUNT DESERT
Practice Address - State:ME
Practice Address - Zip Code:04660-6233
Practice Address - Country:US
Practice Address - Phone:207-812-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist