Provider Demographics
NPI:1457700932
Name:DEVANEY, CARRIE (CMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:DEVANEY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E MATILIJA ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 E MATILIJA ST
Practice Address - Street 2:SUITE K
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2768
Practice Address - Country:US
Practice Address - Phone:314-604-5237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist