Provider Demographics
NPI:1275914806
Name:MCCARVER, TIERNEY (LMP)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:
Last Name:MCCARVER
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 1:8504 N PALM PL
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8989
Mailing Address - Country:US
Mailing Address - Phone:928-848-7471
Mailing Address - Fax:509-466-0175
Practice Address - Street 1:10709 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1631
Practice Address - Country:US
Practice Address - Phone:509-466-8962
Practice Address - Fax:509-466-0175
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60501043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist