Provider Demographics
NPI:1780723734
Name:EMERY, CAROL JEAN (LMP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:EMERY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 111TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1484
Mailing Address - Country:US
Mailing Address - Phone:425-931-4851
Mailing Address - Fax:
Practice Address - Street 1:6501 MOTOR AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1579
Practice Address - Country:US
Practice Address - Phone:253-861-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist