Provider Demographics
NPI:1902155153
Name:CARR, FEILICIA MARIA (LMP)
Entity Type:Individual
Prefix:MS
First Name:FEILICIA
Middle Name:MARIA
Last Name:CARR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:FEILICIA
Other - Middle Name:MARIA
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:3099 TULIBEE CIRCLE
Mailing Address - Street 2:APT. Q-5
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315
Mailing Address - Country:US
Mailing Address - Phone:360-710-5784
Mailing Address - Fax:
Practice Address - Street 1:9216 BAYSHORE DR NW
Practice Address - Street 2:#200
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8533
Practice Address - Country:US
Practice Address - Phone:360-692-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60288174225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist