1578800132 NPI number — MS. CAROL ANNE OTTEN L.M.P.

Table of content: MS. CAROL ANNE OTTEN L.M.P. (NPI 1578800132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578800132 NPI number — MS. CAROL ANNE OTTEN L.M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTEN
Provider First Name:
CAROL
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARONE
Provider Other First Name:
CAROL
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MASSAGE THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578800132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17500 25TH AVE NE UNIT D304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98271-4791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-308-1673
Provider Business Mailing Address Fax Number:
833-538-0165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3210 SMOKEY POINT DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-7805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-308-1673
Provider Business Practice Location Address Fax Number:
833-538-0165
Provider Enumeration Date:
01/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA60327797 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)