Provider Demographics
NPI:1568531598
Name:DECARTERET, BETH J (LMP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:J
Last Name:DECARTERET
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:J
Other - Last Name:HELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:P.O. BOX 1671
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321
Mailing Address - Country:US
Mailing Address - Phone:253-370-6423
Mailing Address - Fax:360-829-5237
Practice Address - Street 1:790 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321
Practice Address - Country:US
Practice Address - Phone:253-370-6423
Practice Address - Fax:360-829-5237
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013437225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist