Provider Demographics
NPI:1831543503
Name:BOEHNLEIN, CARRIE JEAN (CMT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JEAN
Last Name:BOEHNLEIN
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 1:730 BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-3107
Mailing Address - Country:US
Mailing Address - Phone:410-422-3581
Mailing Address - Fax:
Practice Address - Street 1:730 BLAIR AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-3107
Practice Address - Country:US
Practice Address - Phone:410-422-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012935225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist