Provider Demographics
NPI:1578800132
Name:OTTEN, CAROL ANNE (LMP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNE
Last Name:OTTEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:BARONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:17500 25TH AVE NE UNIT D304
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4791
Mailing Address - Country:US
Mailing Address - Phone:425-308-1673
Mailing Address - Fax:833-538-0165
Practice Address - Street 1:3210 SMOKEY POINT DR STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7805
Practice Address - Country:US
Practice Address - Phone:425-308-1673
Practice Address - Fax:833-538-0165
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60327797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist