Provider Demographics
NPI:1417378746
Name:CARPENTER, CARRIE (LMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BEECH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORRIDGEWOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04957-3453
Mailing Address - Country:US
Mailing Address - Phone:207-680-5858
Mailing Address - Fax:
Practice Address - Street 1:155 SILVER ST
Practice Address - Street 2:SUITE# 6
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5813
Practice Address - Country:US
Practice Address - Phone:207-680-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist