Provider Demographics
NPI:1225044027
Name:CARRIGAN, TIANNE CAROLYN (LMP)
Entity Type:Individual
Prefix:MS
First Name:TIANNE
Middle Name:CAROLYN
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:TENINO
Mailing Address - State:WA
Mailing Address - Zip Code:98589-0294
Mailing Address - Country:US
Mailing Address - Phone:360-264-5754
Mailing Address - Fax:806-213-3209
Practice Address - Street 1:448 SUSSEX E.
Practice Address - Street 2:SUITE 2
Practice Address - City:TENINO
Practice Address - State:WA
Practice Address - Zip Code:98589
Practice Address - Country:US
Practice Address - Phone:360-264-5754
Practice Address - Fax:806-213-3209
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013133225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist