Provider Demographics
NPI:1801192042
Name:THOMPSON, CARRIE ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 6TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-2006
Mailing Address - Country:US
Mailing Address - Phone:515-382-2886
Mailing Address - Fax:
Practice Address - Street 1:835 6TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-2006
Practice Address - Country:US
Practice Address - Phone:515-382-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-06
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist