Provider Demographics
NPI:1902006430
Name:CARLILE, KARRIE L (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:L
Last Name:CARLILE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KARRIE
Other - Middle Name:
Other - Last Name:MATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10904 185TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6669
Mailing Address - Country:US
Mailing Address - Phone:253-880-2147
Mailing Address - Fax:
Practice Address - Street 1:3414 A ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-880-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016513225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist