Provider Demographics
NPI:1649528886
Name:HILL, CARISSA (LAC, LMT)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4594 CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6703
Mailing Address - Country:US
Mailing Address - Phone:406-570-1415
Mailing Address - Fax:
Practice Address - Street 1:2417 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3811
Practice Address - Country:US
Practice Address - Phone:406-570-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1070225700000X
MTMED-ACU-LIC-18496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist