Provider Demographics
NPI:1275880239
Name:RASPAOLO, CAROLE ANNE (LMP, BSNHS)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:ANNE
Last Name:RASPAOLO
Suffix:
Gender:F
Credentials:LMP, BSNHS
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1902 E SOUTH RIVERTON AVE
Mailing Address - Street 2:APT 212
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5129
Mailing Address - Country:US
Mailing Address - Phone:509-389-8900
Mailing Address - Fax:
Practice Address - Street 1:670 RIVERSIDE DR.
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-1438
Practice Address - Country:US
Practice Address - Phone:509-846-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60242176225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist