Provider Demographics
NPI:1790074938
Name:KOHL-CARTER, MARJORIE ANN (LMT, CTA)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ANN
Last Name:KOHL-CARTER
Suffix:
Gender:F
Credentials:LMT, CTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 POCAHONTAS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-3027
Mailing Address - Country:US
Mailing Address - Phone:931-273-2693
Mailing Address - Fax:
Practice Address - Street 1:109 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1524
Practice Address - Country:US
Practice Address - Phone:931-273-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist