Provider Demographics
NPI:1922241199
Name:CARLSON, MARGARET LOUISE (BS, LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:LOUISE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NE 3RD ST
Mailing Address - Street 2:STE. 106-136
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3854
Mailing Address - Country:US
Mailing Address - Phone:541-420-6076
Mailing Address - Fax:
Practice Address - Street 1:1900 NE DIVISION ST
Practice Address - Street 2:STE 106
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3525
Practice Address - Country:US
Practice Address - Phone:541-420-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4671225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist