Provider Demographics
NPI:1184012247
Name:CARMICHAEL, TAMESHA PATRICE (MT)
Entity Type:Individual
Prefix:MISS
First Name:TAMESHA
Middle Name:PATRICE
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 SUE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-2241
Mailing Address - Country:US
Mailing Address - Phone:817-842-7577
Mailing Address - Fax:
Practice Address - Street 1:3904 GATWICK CIR
Practice Address - Street 2:2604
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76155-3823
Practice Address - Country:US
Practice Address - Phone:817-842-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59669OtherCAMTC