Provider Demographics
NPI:1710712039
Name:CRAFT, CAROL MARIE (LMT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:CRAFT
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 1:1797 LANSING AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8732
Mailing Address - Country:US
Mailing Address - Phone:503-391-9112
Mailing Address - Fax:866-486-2406
Practice Address - Street 1:1797 LANSING AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8732
Practice Address - Country:US
Practice Address - Phone:503-391-9112
Practice Address - Fax:866-486-2406
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26637225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist