Provider Demographics
NPI:1881217602
Name:BARTLETT, CARRIE ANN (LMT, MMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 243RD AVE
Mailing Address - Street 2:
Mailing Address - City:TREVOR
Mailing Address - State:WI
Mailing Address - Zip Code:53179-9230
Mailing Address - Country:US
Mailing Address - Phone:847-529-3544
Mailing Address - Fax:
Practice Address - Street 1:11815 243RD AVE
Practice Address - Street 2:
Practice Address - City:TREVOR
Practice Address - State:WI
Practice Address - Zip Code:53179-9230
Practice Address - Country:US
Practice Address - Phone:847-529-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14463-146225700000X
IL227.020006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty