Provider Demographics
NPI:1689971228
Name:BRUNK, CAROLYN JEANNETTE (MESSAGE THERAPIST-LI)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEANNETTE
Last Name:BRUNK
Suffix:
Gender:F
Credentials:MESSAGE THERAPIST-LI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 EAST 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-929-1200
Mailing Address - Fax:
Practice Address - Street 1:814 EAST 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926
Practice Address - Country:US
Practice Address - Phone:509-929-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602880736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist