Provider Demographics
NPI:1295344513
Name:MONNSERATT, CAROLEEN THERESA (BP, LMT, BCTMB)
Entity type:Individual
Prefix:MS
First Name:CAROLEEN
Middle Name:THERESA
Last Name:MONNSERATT
Suffix:
Gender:F
Credentials:BP, LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 LOVELAND CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8001
Mailing Address - Country:US
Mailing Address - Phone:907-333-8225
Mailing Address - Fax:907-929-1606
Practice Address - Street 1:6511 E 8TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1779
Practice Address - Country:US
Practice Address - Phone:907-333-8225
Practice Address - Fax:907-929-1606
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101371225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist