Provider Demographics
NPI:1497807499
Name:CORBIN, CARRIE (LMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CORBIN
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:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:KETTLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99141-0681
Mailing Address - Country:US
Mailing Address - Phone:509-738-2911
Mailing Address - Fax:
Practice Address - Street 1:325 E 3 RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KETTLE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99141
Practice Address - Country:US
Practice Address - Phone:509-738-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist