Provider Demographics
NPI:1275827065
Name:CARMEL, KRISTEN (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CARMEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 BATTLE POINT DR NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 NE HOSTMARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6204
Practice Address - Country:US
Practice Address - Phone:360-697-7726
Practice Address - Fax:360-697-7728
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160221218225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant