Provider Demographics
NPI:1326290917
Name:SKIVER, CAROLYN SUE (LMT/CHT/FACIAL SPEC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:SUE
Last Name:SKIVER
Suffix:
Gender:F
Credentials:LMT/CHT/FACIAL SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 CORTEZ RD W
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2739
Mailing Address - Country:US
Mailing Address - Phone:941-932-3625
Mailing Address - Fax:
Practice Address - Street 1:5727 CORTEZ RD W
Practice Address - Street 2:SUITE #4
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2739
Practice Address - Country:US
Practice Address - Phone:941-932-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA25746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist