Provider Demographics
NPI:1336494913
Name:CARPENTER, KAREN LORRAINE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LORRAINE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38792 KALIFORNSKY BEACH ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6443
Mailing Address - Country:US
Mailing Address - Phone:907-598-6252
Mailing Address - Fax:
Practice Address - Street 1:38792 KALIFORNSKY BEACH ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6443
Practice Address - Country:US
Practice Address - Phone:907-598-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist