Provider Demographics
NPI:1689987992
Name:BAUER, CARRIE MICHELLE (LMP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MICHELLE
Last Name:BAUER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 27TH STREET #2
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98284-5602
Mailing Address - Country:US
Mailing Address - Phone:360-840-9201
Mailing Address - Fax:
Practice Address - Street 1:600 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2828
Practice Address - Country:US
Practice Address - Phone:360-848-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00022765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist