Provider Demographics
NPI:1750878351
Name:CARLIN, MARISA JEANETTE (LMT)
Entity type:Individual
Prefix:MISS
First Name:MARISA
Middle Name:JEANETTE
Last Name:CARLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3374 WARD CT
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-6411
Mailing Address - Country:US
Mailing Address - Phone:253-249-8134
Mailing Address - Fax:
Practice Address - Street 1:18310 STATE ROUTE 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8532
Practice Address - Country:US
Practice Address - Phone:253-863-6377
Practice Address - Fax:253-863-2052
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60679010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist