Provider Demographics
NPI:1174043699
Name:CARMACK, RASHELL MAE (LMP)
Entity Type:Individual
Prefix:
First Name:RASHELL
Middle Name:MAE
Last Name:CARMACK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:RASHELL
Other - Middle Name:MAE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:41015 180TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-9127
Mailing Address - Country:US
Mailing Address - Phone:425-229-4631
Mailing Address - Fax:
Practice Address - Street 1:13106 SE 240TH ST STE 202
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-9211
Practice Address - Country:US
Practice Address - Phone:253-360-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60579076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist