Provider Demographics
NPI:1164030839
Name:WEBSTER, CARLY DONN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:DONN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 N MOFFET AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2733
Mailing Address - Country:US
Mailing Address - Phone:417-438-9318
Mailing Address - Fax:
Practice Address - Street 1:740 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5005
Practice Address - Country:US
Practice Address - Phone:417-438-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist