Provider Demographics
NPI:1891827200
Name:WATSON, CARRIE ANN (LMP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:VOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:16235 9TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5824
Mailing Address - Country:US
Mailing Address - Phone:206-412-2745
Mailing Address - Fax:
Practice Address - Street 1:2705 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4738
Practice Address - Country:US
Practice Address - Phone:206-328-7929
Practice Address - Fax:206-328-6066
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist